Pacing below the ventricular rate in terminating ventricular tachycardia and flutter.
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Biomedical subjects
Publications and source records attributed to E Carasca.
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Two types of the initiation of atrial fibrillation are demonstrated in the continuous recordings of right atrial monophasic action potentials. In the first way, more common, atrial fibrillation takes place suddenly after an an extrasystolic atrial beat, in the second one it develops gradually after atrial tachycardia. In the first type the micro reentry starts from the beginning, in the second type only after sustained focal atrial tachycardia.
Two young patients with a-v conduction disturbances occurring in relation with strenuous physical effort are presented. The possible mechanism may be an excessive vagal tone.
A simple method for the study of the WPW syndrome, which can be performed at the patient's bedside, is presented. Using standard ECG, vagal maneouvers, ajmaline test, precordial mapping, vectorcardiography, electrode catheters positioned in the right atrium and esophageal catheters, the site of accessory pathways, and the complex arrhythmias occurring in these patients can be understood and medically treated.
Three patients with repetitive episodes of relatively slow rate (170 beats per minute) ventricular tachycardia, with right bundle branch block (RBBB) QRS morphology during arrhythmia are presented. The clinical and electrophysiological characteristics and the therapeutic problems raised are analysed. The branch to branch reentry mechanism was considered as the underlying mechanism. The peculiar characteristics found in our cases are: almost normal heart, except right bundle branch block in two and left anterior hemiblock in one patient; relatively slow ventricular rate during tachycardia; delayed retrograde ventriculo-atrial conduction during tachycardia; the onset of tachycardia related to atrial or ventricular premature beats; the possibility to stop the tachycardia through ventricular pacing; therapeutical point of view, DC shock, ventricular pacing and iv mexiletin HCl were highly effective, but not iv lidocaine.
Acute hypoxia induced in dogs by breath stopping produces a significant increase of ventricular epicardial monophasic action potential duration, thus an increase in myocardial refractoriness. This may be an explanation of the effect of breath holding test in terminating reentrant cardiac arrhythmias.
In an experimental study indirect sino-atrial conduction time (SACT) was measured, using continuous pacing method from right and left atrial sites, and compared with direct SACT obtained from sinus node potential recording, all the determination being done before and after autonomic blockade. The distance between the two sites of stimulation may be taken into account as a correction factor for SACT determination. The SACT obtained with sinus node potential technique is the same as the indirect SACT after autonomic blockade. These findings are valuable for SACT determination with transesophageal pacing method. Left atrial pacing, thus transesophageal pacing, is a valuable method in estimating the SACT, but a time correction and autonomic blockade is required in order to obtain a real value, eliminating the extrinsic influences.
A personal noninvasive transesophageal pacing technique for the estimation of sinus node function is presented. With a pacemaker device and an esophageal pentapolar catheter, using a correction factor for the left atrial site of stimulation, it is possible to calculate the sinus node recovery time, sinoatrial conduction time and sinus node effective refractory period, before and after autonomic blockade as accurately as by the intracavitary technique.
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Postextrasystolic potentiation may produce in some situations a negative T wave. This situation is presented in two cases, and it is assumed that this phenomenon may be considered as silent myocardial ischemia.