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G Inama

Publications and source records attributed to G Inama.

At least 37 records · Page 2Linked to original sources
PubMed1989

Arrhythmia patterns in athletes with arrhythmogenic right ventricular dysplasia.

Arrhythmogenic right ventricular dysplasia (ARVD) is a typical 'silent' arrhythmogenic cardiomyopathy in athletes, with the possibility of normal ventricular performance and life-threatening arrhythmias. We studied 32 athletes (28 M, 4 F), mean age 23 years, follow-up 6.7 years, all previously declared fit for sports activity. They were studied for significant ventricular arrhythmias with LBBB with a final diagnosis of ARVD based on accepted clinical, echocardiographic and angiographic criteria. The study protocol included Holter monitoring (HM), stress test (ST), electrophysiological endocavitary study (EES), 2D echocardiography, RV and LV cardioangiography and coronarography. The most serious arrhythmia appeared at a mean age of 23.4 years, 20 had clinical sustained ventricular tachycardia (VT) (19/20, 95% during sports activity), six non-sustained VT and one ventricular fibrillation (VF). Severe symptoms occurred in 16/32 athletes (50%) during sports activity in 13/16 (81%): presyncope in nine (non-sustained VT in one, sustained VT in eight); syncope in five (sustained VT); aborted sudden death (SD) in one, SD (follow-up) in one. The reproducibility (HM, ST, EES) of clinically severe arrhythmic manifestations which occurred during sports activity was not high. In fact, during sport many factors are at work which may activate several arrhythmogenic mechanisms not easily reproducible in the laboratory. We conclude that a cardioarrhythmological study is mandatory in suspected right ventricular arrhythmias, including morphological study of the RV, to avoid arrhythmic risk during athletic activity.

Adult↗
PubMed1989

[Arrhythmogenic implications of non-iatrogenic thyroid dysfunction].

We studied all patients with hyperkinetic and hypokinetic arrhythmias, who were recovered in the Cardiology Department and Arrhythmologic Centre of S. Chiara Hospital in Trento between 1983 and 1987. From these we selected all the patients who, on admission, had clinical and biochemical symptoms of dysthyroidism. Of the 2465 patients with cardiac arrhythmias, 93 (3.8%) had an evident thyroid pathology which was due to chronic amiodarone treatment in 42 (44.6%) and was primary and non-iatrogenic in 51 (55.4%). In the latter the thyroid pathology consisted of hyperthyroidism in 43 cases (toxic nodular goitre or Graves' disease), and of hypothyroidism in 8. As regard the types of arrhythmias, hyperthyroidism is predominant in patients with atrial fibrillation (70%) and in those with paroxysmal supra-ventricular reciprocating tachycardia (11.5%), but it is also present in patients with hyperkinetic ventricular arrhythmias (14%). Hypothyroidism is found in patients with hyperkinetic ventricular arrhythmias (25%), atrial fibrillation (37.5%) and atrio-ventricular block (37.5%). The average age of the hyperthyroid population with atrial fibrillation is higher than that of patients with paroxysmal supraventricular reciprocating tachycardia. The control of the thyroid pattern, especially as regards atrial fibrillation and paroxysmal supraventricular reciprocating tachycardia results in absence of arrhythmic episodes even without treatment in 40% of cases, and in an easier drug control in the other cases. Our study indicates that it is necessary to carry out systematic research of a thyroid dysfunction in all patients with cardiac arrhythmias, especially as regards women, atrial fibrillation and paroxysmal supraventricular reciprocating tachycardia. It is also evident that in order to achieve long-term control over hyperkinetic arrhythmia it is very important to overcome hyperthyroidism.

Adolescent↗
PubMed1989

[Transvenous bidirectional shock with a triple electrode system: a promising step in the electrical management of ventricular tachyarrhythmias].

The aim of this work is to assess the reliability of transvenous high energy bi-directional shock with a triple electrode system as the initial step in implanting the automatic cardioverter defibrillator by thoracotomy. During the electrophysiological study on 12 patients, 16 different types of sustained ventricular tachycardia were treated with a 25 J bi-directional QRS synchronized shock delivered through a right ventricular apical cathode and 2 anodes, i.e., the superior vena cava-right atrium and skin patch electrode placed just above the left nipple. A Medtronic 6880 catheter, placed in the right ventricular apex, and a cutaneous patch (CRS, 50 cm2 in surface area) were connected by a cable to a Medtronic model 5350 external cardioverter defibrillator. All but one patient had coronary disease with previous myocardial infarction. The mean VT cycle length was 299 msec (min 200, max 380 ms); 5 VT types had left and 2 had right bundle branch block pattern; 9 had a "bizarre" pattern. The tachycardia was interrupted in 14 types; in 1 type (cycle length 360 msec with "bizarre" morphological pattern) ventricular fibrillation was induced by a well synchronized shock; in 1 type (cycle length 200 msec with "bizarre" morphological pattern) a badly synchronized shock induced a sustained ventricular tachycardia with a longer cycle length (360 msec); this was subsequently stopped by another shock. The transvenous high energy bi-directional shock was quite well tolerated by the patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1988

Induction of supraventricular tachyarrhythmia at rest and during exercise with transoesophageal atrial pacing in the electrophysiological evaluation of asymptomatic athletes with Wolff-Parkinson-White syndrome.

Even today there is controversy as regards the best approach to asymptomatic or slightly symptomatic athletes with the WPW syndrome as regards fitness for sports activity, especially in some countries where the doctor is responsible for certifying sports fitness. This study concerns 84 asymptomatic or slightly symptomatic athletes (66 males, 18 females, mean age 21.7 years, range 12-44 years) who underwent a stimulation protocol the end-point of which was the induction of atrial fibrillation (or, if not possible, atrial tachyarrhythmia) in the basal state and during bicycle stress test with transesophageal atrial pacing. The 81 athletes in whom the end-point was reached were divided into two groups: Group I includes the 32 athletes with the shortest R-R interval between pre-excited beats less than or equal to 240 ms in the basal state and/or less than or equal to 210 ms during bicycle ergometer test, Group II includes the other 49 patients. The evaluation during exercise was not carried out in four athletes because of serious haemodynamic compromise due to the arrhythmia induced in the basal state. Only 21/32 athletes would have been included in Group I if only evaluated in the basal state. In 30/81 athletes (37%), there was discrepancy between the result of stimulation and the result of the usual non-invasive evaluation (Holter monitoring, ergometric stress test, ajmaline test). On average, 40 min are required for the performance of the study protocol except when the induced arrhythmia lasts more than 5 min.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1986

[Electrophysiologic evaluation of athletes with Wolff-Parkinson-White syndrome: induction of supraventricular arrhythmia at rest and under exertion with transesophageal atrial electrostimulation].

The most suitable approach to the athletes with WPW is controversial. Therefore 66 symptom-free athletes with WPW and without heart disease (53 M, 13 F, mean age 21.98 yrs, min 12--max 44) underwent a study protocol whose end-point was the induction of supraventricular tachyarrhythmia, i.e. atrial fibrillation or, if not possible, atrial flutter or atrial tachycardia at rest and during ergometric stress test. The athletes with shortest R-R interval between preexcited beats less than or equal to 240 ms at rest and/or less than or equal to 210 ms during exercise were judged as being at risk i.e. no fit for sport activity. The end-point was reached in 64/66 athletes (in 62 atrial fibrillation). In 4 athletes with life threatening arrhythmia induced at rest the evaluation during exercise was not performed. According to the evaluation at rest we were able to identify only 18 athletes (28.1%) as being at risk, while according to the complete study protocol 26 athletes (40.6%) were judged as such. In 23/64 athletes (36%) this judgement was discordant with the usual non invasive evaluation (i.e. Holter monitoring, ergometric stress test, ajmaline test). During induced atrial fibrillation no significant difference, was found between the percentage of preexcited beats at rest and during exercise. On the average, 40 min. are required for performance of this study protocol (if the induced arrhythmia lasts less than 5 min.). According to our results we conclude: a) the non invasive assessment of the WPW athletes is unsatisfactory; b) the induction of atrial fibrillation during exercise gives a remarkable increase of the diagnostic power with respect to the assessment only at rest; c) since it is simple to perform and not expensive (in time, staff and cost) and because of its high diagnostic yield, we regard this protocol as fundamental for the electrophysiological evaluation of WPW athletes and also suitable for systematic study of WPW patients.

Adolescent↗
PubMed1985

Once per week oral administration of amiodarone in the prophylaxis of supraventricular paroxysmal tachycardia.

In eight patients who had previously responded to treatment with oral amiodarone for prevention of recurrent supraventricular paroxysmal tachycardia, a new regimen of oral amiodarone dosing was evaluated. Each patient received the entire dose, previously taken throughout one week (600 to 1,200 mg), on a single day, once each week. After six weeks on this regimen, all patients were still free of arrhythmias and there were no adverse reactions to the drug. In the first week of the new treatment, amiodarone plasma levels gradually fell from 1.83 mg/l, to 0.48 mg/l, on average. The trough level was similar to that obtained when the drug was given on a daily basis. It is concluded that this new regimen can be used for patients receiving oral amiodarone, and it may be advantageous in improving the compliance of some patients.

Amiodarone↗
PubMed1985

[Sustained ventricular tachycardia in postinfarct ischemic heart disease: spontaneous polymorphism. Clinical, therapeutic and prognostic aspects].

UNLABELLED: Spontaneous Polymorphism (SP) is present when at least two episodes of Sustained Ventricular Tachycardia (SVT) occur spontaneously in the same patient (pt) with different bundle branch block pattern or with shifting of QRS axis by greater than or equal to 90 in the various episodes. We undertook this study in order to investigate the clinical significance of SP in SVT as well as therapeutic and prognostic implications. MATERIAL AND METHODS. From our global pts populations we chose those with SVT in chronic ischemic heart disease (CIHD) with previous myocardial infarction (PMI), they had to be already studied by electrophysiologic technique (EES). The pts were divided into two groups (Gr.): Gr. I: 13 SP pts (12 M, 1 F, mean age 57.5 +/- 13; mean follow-up 19.2 +/- 11 months); Gr. II: 15 no SP pts (14 M, 1 F, mean age 60 +/- 10; mean follow-up 9.9 +/- 13 months). RESULTS: The two Gr. are comparable in terms of symptoms, exercise tolerance, infarct site, intraventricular conduction disturbances (61.5% and 66.6% respectively), ventricular wells kinetics (38.4% and 26.6% respectively) and time interval between acute myocardial infarction the first episode of SVT (7.58 +/- 6.02 and 8.27 +/- 6.57 years respectively). 8 of the 10 alive Gr. I pts have been treated with Amiodarone (A) (2800-4200 mg/wk). All 9 alive Gr. II pts are on A (1400-4200 mg/wk). A serum level in 7 Gr. I pts was 1.7 +/- 0.65 mcg/ml and 1.61 +/- 0.67 in 5 Gr. II pts. 3/13 Gr. I pts died: 2 for sudden death (15.3%), 6/15 Gr. II pts died: 4 suffered sudden death (26.6%).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1985

[Sustained ventricular tachycardia: low-energy transcatheter internal cardioversion. Efficacy, reliability and tolerance in comparison with ventricular burst].

The aim of this study is to evaluate the efficacy, reliability and patient tolerance of low-energy transcatheter intracardiac cardioversion in the treatment of Sustained Ventricular Tachycardia (VT), and to compare this method to ventricular burst. For this purpose 11 patients (pts) (10 M, 1 F, mean age 50.1 yrs, range 24-72) with 18 different types of VT (17 induced during Endocavitary Electrophysiological Study (EES), 1 "clinical"), who all underwent EES all but 1 with organic heart disease, were first treated by transcatheter intracardiac cardioversion and then, if possible, with ventricular burst at 125%-150% of VT rate. The Medtronic Cardioverter 5350 and the Medtronic catheter 6880 were used. The following results were obtained: transcatheter intracardiac cardioversion terminated 9/18 types of VT (8 types at least 3 times) in 6 pts. Cardioversion threshold was on average 1.31 J (range: 0.14-5). Transcatheter intracardiac cardioversion failed to terminate 9/18 types of VT (in 5 pts); VT acceleration or ventricular fibrillation occurred in 6/9 types. The mean cycle length of successfully cardioverted VT (382 +/- 61 msec.) was significantly longer (p = 0.05) than that of not successfully cardioverted VT (284 +/- 83 msec.) and of the VT in whom an acceleration or a degeneration into ventricular fibrillation was observed (240 +/- 55 msec.). In 4 pts it was necessary to use external DC shock and in 4 supraventricular hyperkinetic arrhythmia was induced. All pts complained of considerable discomfort at shocks greater than or equal to 0.5 J. In all the 7 types of successfully cardioverted VT as well as in 3 out of the 4 types of not successfully cardioverted VT in which it was possible to test ventricular burst, this latter proved to be effective. These results indicate that: the efficacy of transcatheter intracardiac cardioversion is not great at least in our pts (50%); moreover, the transcatheter intracardiac cardioversion is affected by a high incidence of acceleration of VT and degeneration into ventricular fibrillation (33.3%) and by the induction of supraventricular hyperkinetic arrhythmia (22.2%). Patient discomfort appears to be a major limitation to transcatheter intracardiac cardioversion. The VT cycle length is determinant for the success of the transcatheter intracardiac cardioversion and for the induction either of an acceleration of VT or of a degeneration into ventricular fibrillation (which are observed only in VT with cycle length less than or equal to 300 msec.).(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗
PubMed1984

[Clinico-electrophysiologic relations in isolated complete atrioventricular block, congenital or idiopathic].

Congenital or idiopathic complete A-V block with no detectable heart disease may be complicated by near syncope, syncope or sudden death. The proposed predictive "risk factors" of these events have not proved sufficiently reliable so far. This study was undertaken in order to re-evaluate the correlation between symptoms and clinical and electrophysiological data with particular regard to the junctional recovery time in 10 patients (4 M; 6 F; mean age 24.4 +/- 9.6 at our first observation) with congenital or idiopathic complete A-V block. Patients were divided into 2 groups: group A (3 M; 3 F; mean age 27.8 +/- 10.6 at our first observation) with patients who complained of vertigo, near syncope or syncope before our study; group B (1 M; 3 F; mean age 19.2 +/- 4.1 at first observation) without cardiovascular symptoms before our study. In group A, Holter monitoring revealed periods of asystole longer than 3000 ms in 2, and ectopic ventricular arrhythmias mainly during effort in 2; ergometric stress test performed in 3 patients demonstrated ectopic ventricular arrhythmias in 2 (those who had ectopic ventricular arrhythmias at rest). In all patients the site of the block was suprahisian (demonstrated by electrophysiologic endocavitary study) with a normal H-V interval; mean junctional recovery time was 4.600 +/- 1.620 ms and corrected junctional recovery time was 3.088 +/- 1.500. Four patients had vertigo during the electrophysiologic endocavitary study. After Atropine 0.02 mg/Kg i.v. junctional recovery time and corrected junctional recovery time decreased respectively to 1052 +/- 238 and 166 +/- 38 ms (the measurement was made in 5 patients). In group B Holter monitoring revealed periods of asystole longer than 3000 ms in 1 case. All patients had ectopic ventricular arrhythmias, confirmed by the stress test. In this group too, the block was suprahisian (electrophysiologic endocavitary study) with normal H-V. Mean junctional recovery time was 5162 +/- 2408 ms; and corrected junctional recovery time 3687 +/- 2202. Two patients complained of dizziness during the electrophysiologic endocavitary study. After Atropine 0.02 mg/Kg i.v., junctional recovery time and corrected junctional recovery time decreased respectively to 1300 +/- 356 and 260 +/- 145 ms. Four group A and 1 group B patients received a permanent pacemaker and have remained asymptomatic since.(ABSTRACT TRUNCATED AT 400 WORDS)

Adolescent↗
PubMed1984

Worsening of arrhythmias during pharmacological treatment.

The widespread use of antiarrhythmic agents to control severe life-threatening arrhythmias evidenced the possibility of a worsening of arrhythmias induced by the same drugs. We performed a retrospective analysis studying the worsening phenomenon in patients who underwent pharmacological invasive and non invasive antiarrhythmic tests to choose the drug to be administered in the chronic treatment. Particularly we reviewed: 101 acute pharmacologic non invasive tests for "stable" ventricular ectopic beats using computerized automatic continuous recording system which allows quantitative and qualitative evaluation of arrhythmias. The drugs tested were: Propafenone (25 patients), Disopiramide (25 patients), Tocainide (11 patients), Lorcainide (8 patients), Lorajmine (13 patients), Nadolol (9 patients). In accordance with Vallebit et al., we considered arrhythmias worsening criteria: the onset of non sustained or sustained ventricular tachycardia; an increase of four fold the number of ventricular ectopic beats and/or ten fold the repetitive forms. A worsening of arrhythmias was observed in 4/101 (3.9% patients); 1/9 treated with Nadolol, 1/25 with Propafenone, 1/35 with Disopiramide, 1/13 with Lorajmine. For one young patient the worsening phenomenon could be considered a toxic picture, because of the very high drug plasmatic levels (Lorajmine) observed for the whole duration of the sustained VT induced from the drug. For the remaining 3 patients the response resambles a paradox effect. 34 pharmacologic invasive tests in 30 patients with common recurrent ventricular tachycardia, during electrophysiologic endocavitary study. The drugs tested were: Propafenone (12 patients), Amiodarone (11 patients), Ajmaline (4 patients), Tocainide (3 patients), Lorcainide (2 patients), Lorajmine (1 patient), Disopiramide (1 patient).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1984

[Clinical experience with propafenone in paroxysmal supraventricular reciprocating tachycardias].

We studied the long term antiarrhythmic efficacy of Propafenon, (300-900 mg/day) in 25 patients (18 females, 7 males; mean age 37,6; follow-up 10 +/- 9,3 months) affected by episodes of disabling paroxysmal supraventricular reciprocating tachycardia. We performed an electrophysiologic study using cardiac catheterization in all 25 patients. Fifteen patients had a Wolff-Parkinson-White syndrome; in 8/25 pts the reentrant circuit was in the atrio-ventricular node and in 2/25 pts it was into the atrium. Ten of fifteen patients with Wolff-Parkinson-White syndrome and 5/8 patients with the reentrant circuit in the atrio-ventricular node have been treated with Propafenon according to the results of the acute test performed during electrophysiologic study. Good results (no recurrences of paroxysmal supraventricular reciprocating tachycardia or less frequent recurrences at a much slower heart rate) have been obtained in 13/15 patients with Wolff-Parkinson-White syndrome and in 5/8 patients with the reentrant circuit in the atrio-ventricular node. The acute drug test with Propafenon during electrophysiologic study was predictive of the clinical response in 100% of patients with Wolff-Parkinson-White syndrome and in 60% of patients with the reentrant circuit in the atrio-ventricular node. We conclude that: 1) Propafenon may be good alternative to Amiodarone in the chronic treatment of pts affected by paroxysmal supraventricular reciprocating tachycardia, especially in patients with Wolff-Parkinson-White syndrome; 2) electrophysiologic study to evaluate Propafenon efficacy is most valuable in patients with Wolff-Parkinson-White syndrome.

Anti-Arrhythmia Agents↗
PubMed1984

[Sustained ventricular tachycardia: induced polymorphism. Clinical and electrophysiological aspects; therapeutic implications].

By induced polymorphism (I.P.) we mean the electrical induction during endocavitary electrophysiologic study (E.E.S.) either of two or more morphologically distinct types of Sustained Ventricular Tachycardia (S.V.T.) (i.e. different bundle branch block patterns or with shifting of QRS by greater than or equal to 90 degrees) or of one type of sustained ventricular tachycardia other than the spontaneous one. Twenty-two patients with clinical sustained ventricular tachycardia, in whom at least one episode of sustained ventricular tachycardia was induced during endocavitary electrophysiologic study, were divided into 2 groups depending on the presence or not of induced polymorphism: Group I consisted of 13 patients with induced polymorphism; Group II consisted of 9 patients without induced polymorphism. All the patients of the Group I had chronic ischemic heart disease (C.I.H.D.); 12/13 previously had myocardial infarction. Only 1 patient of the Group II had chronic ischemic heart disease. Intraventricular conduction defect was present in 9 patients of the Group I and in 2 of the Group II. An overall of 26 sustained ventricular tachycardia episodes were induced in patients of the Group I: 9 with RBBB, 10 with LBBB and 7 with "bizarre" QRS morphology. Sustained ventricular tachycardia reinduction was attempted in 10 patients of the Group I after acute drug testing (Ajmaline, Propafenone, Amiodarone): sustained ventricular tachycardia was no longer inducible in 6, but in 3 of those 4 in whom it was, a marked increase in polymorphism was observed as compared to pre-test pattern. Of the 11 alive patients of Group I, 10 are on Amiodarone alone or in combination with other antiarrhythmic drugs. We conclude as follows: different morphological types of sustained ventricular tachycardia can be quite commonly induced during endocavitary electrophysiologic study; according to our cases induced polymorphism is observed only in patients with chronic ischemic heart disease; patients with induced polymorphism often have intraventricular conduction defect; induced polymorphism furtherly accounts for reentry as the mechanism of sustained ventricular tachycardia in patients with chronic ischemic heart disease; a prevalent morphology of the endocavitary electrophysiologic study induced sustained ventricular tachycardia in patients with chronic ischemic heart disease was not observed at least in our patients; Amiodarone is the drug of choice for the treatment of induced polymorphic sustained ventricular tachycardia patients.

Adult↗
PubMed1984

[Use of transesophageal atrial stimulation in the treatment of atrial flutter. Clinical experience].

Transesophageal atrial pacing with relatively low current output and wide pulse duration has been recently reported. With this method supraventricular tachycardias can be successfully induced and terminated. In this study 23 episodes of spontaneous common atrial flutter (21 patients) were treated by rapid transesophageal atrial pacing (output of 16 Volts and pulse duration of 10 msec). Sinus rhythm resumption was obtained in 18 episodes (78.2%), directly after interruption of stimulation in 7 and following brief periods of atrial fibrillation in 11. All patients tolerated the procedure well with moderate discomfort; no complications were observed. Esophageal pacing offers a useful, rapid, minimally invasive, well tolerated method of terminating atrial flutter in the clinical practice.

Adult↗