Indications for dual-chamber cardioverter defibrillators at implant and at 1 year follow-up: a retrospective analysis in the single-chamber defibrillator era.

AIM: This retrospective four-centre study assessed the current indications for dual-chamber implantable cardioverter defibrillators (ICDs) at implant and during a medium-term follow-up period in a group of patients treated by single-chamber ICD in the pre dual-chamber ICD era. METHODS AND RESULTS: The study population consisted of 153 consecutive patients (127 males, mean age 58 +/- 6 years) treated by single-chamber ICD for ventricular tachycardia and/or ventricular fibrillation. Definite indications for having a dual-chamber ICD included the presence of sinus node dysfunction and of second- or third-degree atrioventricular (AV) block, while possible indications were represented by paroxysmal atrial fibrillation or flutter and first-degree AV block. At implant, dual-chamber ICD would appear definitely indicated in 10.5% of cases, and possibly indicated in an additional 17.5% of cases. During 12 +/- 10 months follow-up, such percentages remained stable (11 and 19.5%, respectively). Inappropriate ICD intervention was documented in five of 13 patients (38%), with episodes of paroxysmal atrial fibrillation or flutter. CONCLUSION: In this non-selected study population, a dual-chamber ICD would have potentially benefited approximately 30% of the patients. During medium-term follow-up, there was no progression towards increasing dual-chamber ICD indications. The 15% cumulative incidence of paroxysmal atrial tachyarrhythmias justifies the activation of dedicated detection algorithms.

[Sepsis and endocarditis: two rare complications following pacemaker implantation. Description of a case and review of the literature]. / Sepsi ed endocardite: due rare complicanze conseguenti all'impianto di pacemaker. Descrizione di un caso e revisione della letteratura.

A case of Staphylococcus aureus tricuspid valve endocarditis in a patient with permanent transvenous VVI pacemaker and recurrent febrile episodes is described. Medical treatment was not effective, and only with surgical removal of the lead was the infection successfully treated.

[Analysis of clinical history and predictive factors in the prognosis of a group of young patients with acute myocardial infarct]. / Analisi della storia clinica e fattori predittivi della prognosi in un gruppo di pazienti giovani con infarto miocardico acuto.

A retrospective study was carried out to examine the clinical history and coronarographic and ventriculographic aspects of a young group of patients aged under 40 affected by acute myocardial infarction. The study confirmed previously published findings with regard to the low rate of mortality, both in hospital and shortly after necrosis. On the other hand, non-fatal ischemic attacks were common in this population and were significantly correlated to the extension of coronary disease. Ischemic complications in this group of patients were mainly treated using coronary revascularisation (by-pass or PTCA), procedures which have been proved efficacious in preventing further ischemic events during the medium term. The results of the study indicate the need for a more aggressive approach, with the use of predischarge coronarography even in the absence of residual ischemia. This would not only serve to ascertain the degree of coronary disease or revascularisation, but above all would enable a prognosis to be given regarding the patient who, in psychological terms, should not be considered an invalid following acute ischemia.

[Hemorrhages of the upper gastrointestinal tract. A comparison of the diagnostic accuracy between endoscopic and radiological examinations]. / Le emorragie del tubo gastroenterico superiore. Raffronto dell'accuratezza diagnostica fra esame endoscopico e radiologico.

One hundred and forty-eight patients admitted for upper gastrointestinal hemorrhage, but excluding esophageal varices, underwent optic fibre gastroscopy at the time of admission and were then examined using a barium meal after a 24-48 h interval. The aim of the study was to compare the sensitivity, specificity and diagnostic accuracy of the two tests. A correct diagnosis was obtained using both procedures in 58.2% of cases. Endoscopy provided an accurate diagnosis in 35.1% of patients, whereas gastrointestinal x-rays showed the exact site of the lesion in only 6.7% of cases. Endoscopy had a sensitivity of 92.5% compared with 60.7% for the barium meal. Endoscopy also had a higher level of specificity (100%) versus the barium meal (33.3%). The results obtained from the pathological examination of specimens confirmed the accuracy of endoscopy. In conclusion, early endoscopy is a reliable procedure in the emergency assessment of the hemorrhaging patient; routine x-ray examination does not appear to add additional information and may be reserved for subsequent use if endoscopy gives doubtful or misleading indications of the site of bleeding.

[Angina pectoris induced by oral administration of dipyridamole]. / Angina pectoris indotta dalla somministrazione orale di dipiridamolo.

Five cases scheduled for myocardial elective coronary artery bypass (CAB), who developed angina and ischemic electrocardiographic changes, after oral administration of dipyridamole (100 mg) are reported. Dipyridamole induced myocardial ischemia has been demonstrated in subjects with coronary artery disease, if this drug is administered intravenously. To our knowledge, only one study reported this side effect, after oral route, in four patients awaiting urgent CAB, for unstable angina. Based on our and other Authors experience, preoperative dipyridamole should be used with caution, especially in patients with unstable angina.

[Mesenteric venous hypertension in an adolescent with common ileocolic mesentery]. / Ipertensione venosa mesenterica in un adolescente con mesentere ileocolico comune.

The case of a twelve year-old boy suffering from "common ileocolic mesentery" with surgical finding of very serious splanchnic venous dilatation is presented. Mesenteric arteriography was the most useful test for diagnosis. The surgical technique has been compared with that described by other Authors.