DDD pacing and interatrial conduction block: importance of optimal AV interval setting.

The case of a 83-year-old patient undergoing DDD pacemaker implantation for sick sinus syndrome with postimplant detection of advanced interatrial conduction block is described. At nominal AV interval programming values (175 ms), absence of P wave following an atrial spike was observed, and the presence of an interatrial conduction disturbance was demonstrated by a Doppler transmitral flow pattern analysis and transesophageal ECG recording. AV interval lengthening up to 300 ms resulted in proper timing of atrial and ventricular contractions. Awaiting for conclusive data about biatrial pacing, interatrial conduction blocks can be managed in some cases by proper programming of conventional DDD systems.

[Single-lead VDD pacing with sensing dipole in the coronary sinus: a case of implantation through persistent left superior vena cava]. / Stimolazione VDD monocatetere con sensing in seno coronarico: un caso di impianto attraverso vena cava superiore sinistra persistente.

We report the case of a VDD single-lead pacemaker implantation through a persistent left superior vena cava in a 48-year-old male patient with recurrent episodes of syncope due to paroxysmal atrioventricular block. VDD lead insertion through the anomalous venous structure led to positioning of the floating sensing dipole into the coronary sinus, in a very large and stable sensed atrial signal due to the close anatomic relationship between the coronary sinus and the left atrium. Shortness of the sensed atrioventricular interval allowed VDD stimulation to occur only in the case of paroxysmal atrioventricular block.

[Atherosclerosis: the risk factors]. / Aterosclerosi: i fattori di rischio.

A group of 196 outpatients among whom 112 non-insulin-dependent diabetics were divided into 4 subgroups according to whether they had vascular disorders or not. For statistical evaluation by means of correlation coefficient and chi-square test both risk factors (smoking, family history, arterial hypertension, BMI) and laboratory values (total and HDL cholesterol, triglycerides, fibrinogen, HbA1c, factor VIII, PF4, BTG) were taken into account. Our findings confirm the relevance of risk factors and the need for diabetic patients to be metabolically well balanced; PF4, BTG, and factor VII were normal in all patients which suggests that these are not suitable, as far as the present study is concerned, to be considered markers of vascular disorders. An interesting correlation was found between these factors and serum triglycerides, especially in the subgroup of diabetics with vascular disorders. An interesting finding was the increase of fibrinogen in subjects with vascular disorders especially in non-diabetics.

Complications of single lead VDD pacing in 35 patients with AV block.

The implantation of a VDD system is comparable to that of a VVI system, but its management is associated with typical complications of dual chamber pacing. In 35 patients with symptomatic AV block and normal sinus node function, two different VDD pacing systems were implanted. Most of the complications described and their mode of resolution were common to VDD and DDD pacing; however, the VDD system eliminated the need for two separate leads. We, therefore, favor single lead VDD pacing in the treatment of complete AV block with normal sinus node function.

[Apical hypertrophic cardiomyopathy: description of a case in advanced age with documentation of electrocardiographic course]. / Cardiomiopatia ipertrofica apicale: descrizione di un caso di età avanzata con documentazione della evoluzione elettrocardiografica.

We describe a case of non-obstructive apical hypertrophic cardiomyopathy in an 86-year-old Caucasian patient, whose electrocardiographic and echocardiographic patterns coincided with those originally described by the Japanese Authors. We documented the evolution of the patient's electrocardiographic alterations over a 16-year period, in absence of symptoms, except for one syncopal episode, which occurred 13 years ago.