[Electrophysiological studies in patients with recurrent ventricular tachycardias].
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Biomedical subjects
Publications and source records attributed to J Farré.
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Three patients with reentrant tachycardia are described who had an accessory pathway with a very long conduction time that was incorporated in the tachycardia circuit. The accessory pathway was able to conduct in one direction only, in retrograde manner in two patients and in anteriograde manner in the remaining patient. Evidence is presented that reveals that in the first two patients the accessory pathway was septally located, had completely bypassed the normal atrioventricular (A-V) conduction system, had properties of decremental conduction, and had an atrial exit close to the coronary sinus and a ventricular exit relatively far from the atrioventricular A-V ring. In the third patient, who manifested wide QRS complex during tachycardia, the ventricular end of the accessory pathway seemed to be located close to the right ventricular apex. The atrial end of the pathway could not be localized exactly.
Electrophysiologic studies in patients with the Wolff-Parkinson-White (WPW) syndrome are performed for diagnostic and therapeutic reasons. Surface electrocardiographic leads plus intracardiac electrograms from different locations are stimultaneously recorded. Programmed electrical stimulation of the heart permits confirmation of pre-excitation in questionable cases and assessment of the mechanism of the arrhythmias which these patients develop as well as their therapeutic approach. The most frequent form of paroxysmal regular tachycardia observed in WPW is based on an AV-junctional re-entry mechanism utilizing the accessory pathway in the retrograde direction. The second clinically relevant arrhythmia encountered in these patients is atrial fibrillation with very rapid ventricular rates due to almost exclusive A-V conduction by way of the accessory pathway. Ventricular fibrillation may occasionally ensue as a result of these fast ventricular rates during atrial fibrillation. Determination of the antegrade effective refractory period of the accessory pathway may identify the group of patients prone to the development of this complication. The intravenous injection of Ajmaline can by a non-invasive aid in the selection of patients for further electrophysiological evaluation when this drug fails to induce complete antegrade block over the accessory pathway during sinus rhythm. Patients with tachyarrhythmias which are difficult to control with conventional drug therapy should undergo an electrophysiological investigation to select either more effective antiarrhythmic treatment or, in medically refractory patients, appropriate pacing or surgical techniques.
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A 41-year-old woman had a left palatal tumor diagnosed as psammomatoid ossifying fibroma. This tumor is a rare subtype of benign fibro-osseous craniofacial lesion that occurs mainly in women, younger age groups, and the sinonasal tract. It has distinctive histomorphological features. The tumor is slow-growing but tends to be locally aggressive and to destroy adjacent anatomic structures. Surgical excision with broad margins is the treatment of choice.
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