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Biomedical subjects

A Proclemer

Publications and source records attributed to A Proclemer.

At least 37 records · Page 2Linked to original sources
PubMed1996

Intravenous propafenone in paroxysmal atrial fibrillation: a randomized, placebo-controlled, double-blind, multicenter clinical trial. Paroxysmal Atrial Fibrillation Italian Trial (PAFIT)-2 Investigators.

BACKGROUND: Pharmacological conversion of paroxysmal atrial fibrillation is frequently necessary. The aim of this study was to compare intravenous propafenone, a class Ic antiarrhythmic agent, with placebo in paroxysmal atrial fibrillation (AF) of recent onset (< 72 h). PATIENTS AND METHODS: We randomly allocated 75 patients, aged 18 to 70 years, with paroxysmal AF to receive intravenous propafenone (2 mg/kg in 15 min followed by 1 mg/kg in 2 h) or the matching placebo. Patients were followed for 3 h. Exclusion criteria were the presence of one of the following: clinical heart failure, recent acute myocardial infarction, hypotension, atrioventricular block, Wolff-Parkinson-White syndrome, or current treatment with antiarrhythmic agents or digitalis. RESULTS: No sign of heart disease was found in 74.7% of the patients. Echocardiographically determined left atrium diameter was similar in the two groups. Conversion to sinus rhythm occurred in 24 of 41 patients allocated to propafenone and in 10 of 34 patients allocated to placebo (odds ratio 3.2, 95% confidence intervals 1.3-7.9; p < 0.01). Mean conversion time was 34 +/- 29 and 71 +/- 55 min, respectively, for propafenone and placebo. Mean heart rate in nonconverters decreased from 146 to 109 beats/min in patients treated with propafenone while it remained virtually unchanged in those treated with placebo. Only minor side effects were noted. CONCLUSIONS: Intravenous propafenone is an effective therapeutic option for restoring sinus rhythm in patients with paroxysmal AF of recent onset.

Adolescent↗
PubMed1996

Clinical challenge. II. Management of recent onset atrial fibrillation. PAFIT-2 Investigators.

Atrial fibrillation is a very common arrhythmia in patients with structural heart disease, but it also occurs in patients without underlying heart disease. Acute therapy for paroxysmal atrial fibrillation is very dependent on the clinical condition of the patient. Direct current cardioversion is usually the first choice whenever the arrhythmia precipitates heart failure or severe angina, while more stable patients are normally treated with drugs. Most episodes of atrial fibrillation eventually convert to sinus rhythm even in the absence of treatment. Antiarrhythmic drugs can be used to control the ventricular response or to restore sinus rhythm, and several have been tested to assess their ability to convert recent onset atrial fibrillation. The success rate has varied, but generally flecainide and propafenone appear the most effective. Digitalis and calcium channel blockers do not increase the likelihood of reversion but they reduce ventricular rate. Amiodarone has been tested as a possible alternative to flecainide and propafenone. The pros and the cons of these and other drugs in the setting of paroxysmal atrial fibrillation will be discussed. In particular, special emphasis will be given to the differences in the design and in patient selection of the trials that tested antiarrhythmic drugs in paroxysmal atrial fibrillation.

Anti-Arrhythmia Agents↗
PubMed1993

Risk stratification and prognosis of patients treated with amiodarone for malignant ventricular tachyarrhythmias after myocardial infarction.

Seventy-seven consecutive patients (mean age 62 years) with episodes of sustained ventricular tachycardia (VT) or ventricular fibrillation (VF) after acute myocardial infarction (AMI) were evaluated to assess the long-term efficacy of first-line amiodarone treatment and to identify clinical and laboratory factors associated with a high risk of death or arrhythmia recurrence. The presenting arrhythmia was VT in 41 cases (53%) and VF in 36 (47%). VT or VF occurred between the 4th and 90th day after AMI in 45 cases (58%) and later (more than 90 days) in the remaining 32 (42%). The mean number of arrhythmic episodes was 4.2. Forty patients (52%) were in New York Heart Association (NYHA) class I or II, and 37 (48%) were in class III or IV. Mean left ventricular ejection fraction was 32%; ventricular aneurysm was present in 41 subjects. Most patients had multivessel coronary artery disease. Amiodarone was administered as a first-choice drug in all patients, in combination with other antiarrhythmic drugs in 14. By ventricular stimulation after loading doses of amiodarone, sustained VT was inducible in 46 (62%) and noninducible in 28 (38%). During a mean follow-up of 28 months the incidence of cardiac mortality at 1, 3, and 5 years was 21%, 37%, and 47%; of sudden death was 7%, 19%, and 23%; of nonfatal VT recurrence was 13%, 13%, and 24%, respectively. The overall incidence of amiodarone side effects was 35%.2+ was a weak predictor only by univariate analysis (p = 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

[Recurrent ventricular fibrillation, right bundle-branch block and persistent ST segment elevation in V1-V3: a new arrhythmia syndrome? A clinical case report].

In this report we describe a patient with a rare arrhythmic syndrome, recently reported and characterized by aborted sudden death, right bundle branch block and persistent ST segment elevation in precordial leads. The patient is a 65-year-old man, who had survived recurrent episodes of ventricular fibrillation (VF). The ECG during sinus rhythm revealed the coexistence of right bundle branch block and persistent ST segment elevation (1-4 mm) in leads V1-V3. The clinical and laboratory investigations, including echocardiography, cardiac catheterization and right endomyocardial biopsy, could not identify any significant morphological and functional cardiac abnormalities. The presence of late potentials (high gain ECG), and the inducibility of VF during the electrophysiological study, suggest a functional reentry as arrhythmogenic substratum. During a 60-month follow-up period, high-dose amiodarone per os, and subsequent AICD therapy successfully treated recurrent VF episodes. This clinical case confirms the existence of a new idiopathic malignant arrhythmic syndrome. Aggressive antiarrhythmic therapy seems fundamental in this type of patients.

Aged↗
PubMed1992

[Paroxysmal atrial arrhythmias in arrhythmogenic cardiomyopathy of the right ventricle with a familial character: the role of right atrial involvement].

Arrhythmogenic right ventricular cardiomyopathy presents a rather frequent familial occurrence. In the present study the cases of two brothers (25 and 30 years old, respectively) presenting with the peculiar finding of early involvement of right atrium, are described. Both subjects were investigated because of recurrent complex arrhythmias, including supraventricular (sustained atrial flutter, atrial tachycardia) and ventricular tachyarrhythmias (very frequent premature beats, nonsustained ventricular tachycardia). The associated echo-angiographic aspects of the right atrium and right ventricle were those typically described in arrhythmogenic right ventricular cardiomyopathy. The familial occurrence of simultaneous right atrial and ventricular involvement, to the best of our knowledge not previously described, can likely be due to the similar phenotypic expression of the same genotype. The prognostic significance of atrial involvement in right ventricular arrhythmogenic dysplasia is still to be defined and the clinical follow-up of these two cases may contribute to it.

Adult↗
PubMed1991

[Percutaneous aortic valvuloplasty in adults: prediction of the immediate result and current indications].

Here we present a series of 45 patients (21 M and 24 F) between the ages of 36 and 91 (average age: 71 +/- 8), who underwent Percutaneous Aortic Valvuloplasty (PAV) between Oct. 1986 and Dec. 1989. We used the traditional retrograde technique with balloon catheters sized 20 or 23 mm, with the exception of the first stage in which the kissing balloon technique was used in 7 cases. The calculated mean increase in aortic valve area (AVA) was 55.6 +/- 38% (from 0.49 +/- 0.11 cm2 to 0.74 +/- 0.07 cm2) and the peak gradient was reduced from 83 +/- 16 to 41 +/- 13 mmHg. We could observe only two relevant complications, i.e., two pulsating femoral artery haematomas at the site of catheter insertion. This artery underwent elective surgical resection two weeks after PAV. The dishomogeneity of the survey, due not only to the complexity of the valvular stenosis functional anatomy, but also to the changes in the PAV indications observed during the three-year period, led us to appraise our results by using a score based on the following features: valvular calcification degree (0-2); commissural fusion extent (0-4); bicuspid of tricuspid valve (0-2); and predilatation valve area less than 0.5 or greater than or equal to 0.5 cm2. In this way we were able to identify two groups of patients, one having a score of less than or equal to 6 (group I, 25 patients) and the other having a score of greater than or equal to 8 (group II, 20 patients). Mean AVA increase was 29% in group I and 84% in group II. At 24 +/- 6 months clinical follow-up, a significant discrepancy was maintained; the two groups showed a 5% and a 37.5% improvement, respectively. The score we suggest seems to single out cases with a high likelihood of success, i.e. the achievement of an AVA higher than 0.9 cm2. This seems to be helpful for a better selection of patients. Using this score as the basis for such an immediate result predictability, we believe that PAV could be advisable in the following cases: a) palliation for elderly patients (greater than 80 years) or patients with contraindications for valve replacement; b) as a bridge to surgical intervention; c) emergency procedures such as bailout valvuloplasty; d) diagnostic clarification in the most complex cases where a severe reduction in ventricular function and cardiac output, together with a low transvalvular gradient are present.

Adult↗
PubMed1990

[Syncope of unknown origin after electrophysiologic study: is the treatment with pacemaker useful?].

The usefulness of pacemaker treatment appears doubtful in patients suffering from syncope of unknown origin after a complete diagnostic evaluation, which includes electrophysiological study. To better assess the effectiveness of this therapy, 24 patients with syncope of unknown origin and negative electrophysiological study were prospectively and alternatively assigned to treatment with pacemaker (group A) vs treatment without pacemaker (group B). Group A included 12 patients (7 males, 5 females) with a mean age of 64 +/- 10 years. No heart disease was present in 7 cases (58%); 3 cases had chronic ischaemic heart disease (25%) and 2 had hypertensive heart disease (17%). The standard ECG was normal in 7 patients, while various conduction abnormalities were observed in the other 5. The mean number of syncopal episodes was 4.8 +/- 3.9 per patient, and the mean between the onset of symptoms and the beginning of this study was 32 +/- 42 months. In these 12 cases a VVI-M pacemaker was implanted, at a programmed rate of 50 or 60 bpm; in three subjects, the pacemaker was of the diagnostic type ("bradycardia event counter"). Group B included 12 patients (8 females, 4 males) with a mean age of 56 +/- 11 years. Organic heart disease was absent in 7 cases (58%); 4 patients showed hypertensive heart disease (33%) and 1 had mitral prolapse (9%). The ECG was normal in 9 subjects. The mean number of syncopes was 3.2 +/- 1.5 per patient; the mean interval since the onset of symptoms was 18 +/- 19 months.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1990

[Malignant ventricular arrhythmias in the subacute and late phases of myocardial infarction. Clinical arrhythmological characteristics and prognostic value].

The purposes of this study are as follows: 1) to describe the clinical and arrhythmological characteristics of 30 patients (23 male, 7 female, mean age: 61 years) who suffered from episodes of ventricular tachycardia and/or ventricular fibrillation between the 7th and the 90th day following acute myocardial infarction; 2) to evaluate the effectiveness of treatment with amiodarone also taking into account the results of electrophysiologic study; 3) to correlate our results with data from previous studies. The site of the acute myocardial infarction was anterior in 16 patients, inferior in 12, and anterior and inferior in 2. Twenty patients had early post-acute myocardial infarction complications (67%) such as cardiac failure (16), bundle branch blocks (9) and ventricular fibrillation in the first 48 hours (6). The mean ejection fraction was 33 +/- 8% and a left ventricular aneurysmatic evolution was observed in 13 patients (43%). The first episodes of spontaneous ventricular arrhythmias occurred after a mean interval of 32 +/- 24 days following acute myocardial infarction. These occurred in the form of ventricular fibrillation in 19 patients (63%) and of ventricular tachycardia in the other 11 (37%). The patients experienced 5.6 +/- 5 episodes of ventricular fibrillation or ventricular tachycardia. Of the 30 patients, 28 received amiodarone, 1 procainamide and 1 propafenone. Five of the 28 patients treated with amiodarone were also given either procainamide or propafenone due to the early recurrence of ventricular tachycardia or fibrillation. One patient underwent early left ventricular aneurysmatic resection due to refractory ventricular fibrillation. Two groups of patients were distinguished on the basis of the electrophysiologic study results obtained during anti-arrhythmic treatment: group A consisted of 17 cases in which a sustained ventricular tachycardia was inducible (57%), group B consisted of 13 cases in which a sustained ventricular tachycardia was not inducible (43%). During a mean follow-up period of 31.6 +/- 26 months the total mortality rate was 23% in group A and 46% in group B (p = ns), the incidence of sudden death was 17% in group A and 23% in group B (p = ns), the incidence of non fatal ventricular tachycardia or ventricular fibrillation recurrences was 24% in group A and 0% in group B (0.05 less than p less than 0.1). One group A patient successfully underwent a heart transplant. The negative predictive value of ventricular stimulation in relation to sudden death and to non-fatal arrhythmic recurrences was 77% and 100%; the positive predictive value was 17 and 28%.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗
PubMed1989

Long-term follow-up of patients with unexplained syncope and negative electrophysiologic study.

Fifty-eight patients (29 M, 29 F, mean age 60.8 +/- 16 years) with unexplained syncope at the end of a complete clinical and electrophysiological evaluation, were followed for a mean period of 36.6 +/- 20.5 months (median: 30.5 months). Structural heart disease was present in 32 patients (55.2%). The standard ECG was normal in 24 (41.4%) and showed sinus bradycardia (greater than 40 m-1) and/or first degree AV block and/or intraventricular conduction disturbances in 29 patients (50%). During follow-up, recurrences of syncope were observed in 11 of 43 untreated patients (25.6%), three of seven electrically treated patients (42.9%) and two of eight pharmacologically treated patients (25%). The cause of these recurrences was cardiac in one (1.7%), non-cardiac in 10 (17.2%) and remained undetermined in five (8.6%). Sudden death occurred in only one patient (1.7%), who was receiving chronic amiodarone therapy. These results indicate that (1) syncopal recurrences may occur in an appreciable percentage of patients with unexplained syncope and a negative electrophysiologic study during a relatively long-term follow-up, (2) syncopal recurrences, when they occur, are generally due to a non-cardiac cause, (3) sudden death is an occasional and rare event in this patient population and (4) empirical prophylactic treatment with a permanent pacemaker or antiarrhythmic drugs does not usually prevent complications during the follow-up.

Adult↗
PubMed1989

Right ventricular tachycardia with left bundle branch block and inferior axis morphology: clinical and arrhythmological characteristics in 15 patients.

UNLABELLED: Fifteen patients (mean age 30) presenting with right ventricular tachycardia (VT) of the outflow tract type (left bundle branch block with inferior axis morphology), in the absence of obvious organic heart disease, were studied. Seven patients had palpitations, one presyncope and seven were asymptomatic. The echo and/or angiographic findings were normal in 11 patients (73%), suggesting arrhythmogenic right ventricular dysplasia (ARVD) in three (20%) and dubious in one (7%). The VT was sustained in three patients (20%), nonsustained (11 +/- 6 beats) in twelve (80%), inducible during exercise in two out of 15 patients (13%) and with ventricular stimulation in one out of eight (12.5%). Four patients were treated with sotalol, three with Class IC drugs and one with amiodarone. At follow-up of 36 +/- 30 months, only three patients had VT recurrences due to drug withdrawal. IN CONCLUSION: (1) abnormal echo and/or angiographic findings suggested that ARVD was observed in a minority of the patients (22%); (2) the low inducibility of VT and the good response to sotalol suggested a possible mechanism of abnormal automaticity; and (3) at a 3-year follow-up the prognosis appeared to be good in both patients with or without echo-angiographic signs suggestive of right ventricular dysplasia.

Adult↗
PubMed1988

[Atrial involvement in arrhythmogenic right ventricular dysplasia: primary or secondary? Description of a case of occult ventricular dysplasia with right atrial enlargement and exclusively sinoatrial arrhythmia].

The atrial involvement in patients with arrhythmogenic right ventricular dysplasia is very rarely described. We here describe a patient with right atrial enlargement suffering from classical sinus and atrial electrical disease (tachycardia-bradycardia syndrome); the associated echo-angiographic aspects of the right ventricle are compatible, even in the absence of ventricular tachyarrhythmias, with a concealed form of right ventricular dysplasia. A common pathogenetic mechanism for the atrial and ventricular involvement is hypothetically considered.

Arrhythmias, Cardiac↗
PubMed1988

[Permanent idiopathic sinus tachycardia in pregnancy. Description of a case].

A 35 year old primigravida presented a rare arrhythmia defined as persistent idiopathic sinus tachycardia, which appeared strongly symptomatic during the first weeks of pregnancy. Based on electrophysiological evaluation and pharmacological tests, we retained that the pathogenetic mechanism was due to enhanced automaticity in the sinus node, or in a near "atrial ectopic focus", as a result of a localized autonomic dysfunction. The maternal-foetal prognosis resulted extremely favorable thanks to antiarrhythmic drug association during the last six months of pregnancy.

Adult↗
PubMed1987

Electrophysiological effects of bisoprolol.

The aim of this study was the electrophysiological evaluation of bisoprolol, a new highly cardioselective beta blocker, void of intrinsic sympathomimetic activity and without significant membrane stabilizing action. 10 patients (4 males and 6 females, mean age 67.5 years) with cardiac arrhythmias or syncopes of undetermined origin underwent His bundle recording with incremental as well as programmed atrial and ventricular pacing in an electrophysiological study. Electrophysiological parameters were measured at basal conditions and at 15 and 30 minutes after the infusion of bisoprolol 5 mg (for patient 1 to 5) and 10 mg (for patient 6 to 10). All electrophysiological parameters were within normal range at basal evaluation. Bisoprolol prolongs significantly sinus cycle length, corrected sinus node recovery time, AH interval, cycle length inducing AV-node block, effective and functional refractory periods of the AV-node. All these parameters remained within normal limits and were modified to about the same extent by 5 and 10 mg of the drug. No drug-related changes of QT interval were observed. Bisoprolol have been confirmed to have strictly beta-blocking properties.

Adrenergic beta-Antagonists↗
PubMed1987

[Usefulness of the electrophysiologic study in the prognostic evaluation of patients with syncope of uncertain origin].

UNLABELLED: Recurrent, sudden temporary loss of consciousness is a common clinical problem: in the absence of electrocardiographic monitoring during a syncopal episode (S), abnormalities demonstrated by an electrophysiological study (ES) may suggest the etiology of S. We have performed a complete ES in 53 Pts (M. 38-F. 15, mean age 63 y.) with recurrent unexplained S (3.8 S/pt) by means of a standardized protocol. Group I: 30 Pts (mean age 65 y, 3.6 S/pt) with structural heart disease. Thirteen of these had abnormal ES findings: inducible ventricular tachycardia in 6, prolonged HV interval in 7 (with bundle branch block), very fast atrial flutter in one. Group II: 23 Pts (mean age 61 y., 3, 9 S/pt), without organic heart disease. The ES was abnormal in 14 Pts showing a prolonged HV interval in 11 (with bundle branch block), an intrahisian block in 1 and an inducible AV nodal tachycardia with heart rate greater than 200/m' in one. Only the Pts with abnormal ES were treated according to their condition with amiodarone or with an implantable pacemaker. Three PTs with C.H.D. and normal ES successfully underwent by-pass surgery. During the follow-up (20 months) therapy based on ES provided symptomatic relief (no S) in 25 of 26 Pts with abnormal electrophysiological study. Syncope persisted in 4 of 26 Pts in whom ES did not define a mechanism of S. No sudden death in any Pt. CONCLUSIONS: ES was, therefore, of diagnostic value in more than half of the patients with syncope of unknown cause and long-term treatment based on ES was successful in the prevention of S (remission rate of 93% in patients treated with amiodarone or pacemaker).

Adult↗