[Guidelines for the use of the implantable defibrillator. Combined task force of the Italian Group of Arrhythmia and the Italian Association of Cardiostimulation].
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Biomedical subjects
Publications and source records attributed to M Santini.
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The authors in explaining their limited clinical experience relative to one single case, describe the peculiarity of Takayasu's disease and its rare incidence in western populations. The case under observation because of its peculiar rarity had been underestimated and treated in a completely inappropriate manner. Important instrument in its diagnosis is the High Resolution echography which in determining the diagnosis favors and speeds up the diagnostic therapeutic iter.
Smooth muscle cell proliferation is a step of the repair process after vascular injury. A similar process occurs after percutaneous transluminal angioplasty and can lead to intimal hyperplasia and vascular restenosis. We have recently observed this process in an anastomotic restenosis after saphenous vein by-pass in the popliteal artery. We suppose that myointimal hyperplasia can also be an aspecific response to surgical intimal injury.
Tuberous sclerosis, first described by Bourneville in 1880, is a syndrome characterized essentially by mental deterioration, seizures and cutaneous sebaceous adenoma; an association with malformative lesions of the kidney and cardiovascular apparatus has been documented. Recently a case of a young woman with tuberous sclerosis has come to our observation; she was also affected by abdominal aortal aneurysm and stenosis due to compression of the truncus coeliacus; previously she operative elsewhere for right nephrectomy for breakage of nephric right arterial aneurysm: the histological examination of the removed kidney manifested the presence of a mesoblastic nephroma and afterward tuberous sclerosis was diagnosed. The angiomyolipomatosis evidence confirmed the suspicion of a notable inclination to polydistrict malformations in tuberous sclerosis.
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A large population of sick sinus syndrome (SSS) patients was analyzed to determine whether age of patients, presence of conduction disturbances and mode of permanent pacing are related to the occurrence of supraventricular tachyarrhythmias, cerebral embolism and cardiac mortality. Three hundred thirty-nine patients permanently paced (135 AAI, 79 DDD, 125 VVI) because of SSS were followed for a mean period of 5 years (range 2 to 10). Patients were divided into 4 groups according to age (less than 70 or greater than 70 years) and the presence or absence of an associated conduction disturbance. Sixty-eight percent of VVI, 55% of AAI and 40.5% of DDD patients were greater than 70 years of age. In the VVI and DDD groups a conduction disturbance was present in 67 of 204 (33%) patients; conduction disturbances were more common in patients greater than 70 years old (46 of 111, 41%) than in those less than 70 years old (21 of 93,22%). The Wenckebach threshold (greater than 140 beats/min) remained unchanged during the follow-up period in 82% of AAI patients. In 9% of these patients, the Wenckebach threshold showed some degree of deterioration, but only in 2 patients was it less than 100 beats/min (1.5%). Spontaneous second-degree atrioventricular block was observed in 7 patients (5%); it disappeared in 6 of these patients when drug therapy was discontinued.(ABSTRACT TRUNCATED AT 250 WORDS)
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Three patients affected by dilated cardiomyopathy complicated by refractory ventricular tachycardia, with a high risk of sudden cardiac death, underwent transcatheter electric fulguration. The technique was applied transeptally, using the terminals of two catheter electrodes as cathode and anode. These were placed at the right and left ventricular apex, at septal level where the "critical" arrhythmia point had been identified by endocardial mapping. All patients had previously experienced more than one episode of cardiac arrest and had successfully taken several antiarrhythmic drugs. All patients presented variable morphology of ventricular tachycardia (whether spontaneous or induced). In all of them clinical tachycardia was considered as having a left bundle branch block morphology with an earlier activation at low septal level. After treatment, antiarrhythmic therapy (amiodarone 200 mg/day) was continued for all patients, although at a lower dose than before fulguration. One patient has been free from sustained ventricular tachycardia for more than two years after fulguration. In the other patients we observed an early and late arrhythmic recurrence (respectively within 1 and 8 months following fulguration) in spite of antiarrhythmic therapy. The second patient presented no further recurrence after permanent pacemaker implantation. The third patient showed an arrhythmic recurrence, with a different morphology from the previous one, concomitantly with a septic process. This technique does not appear dangerous and may be used, in highly specialized centres, on carefully selected patients as a therapeutic approach after pharmacological therapy and before automatic defibrillator implantation or surgical antiarrhythmic intervention.
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The Authors have re-examined their case histories of 1503 patients who have had 2459 pacemakers implanted and who have undergone check-ups as outpatients. All the complications which have arisen from 1967 to the present have been taken into consideration. The total number of complications has been found in 355 patients with 14% of the total number of pacemakers and they have been subdivided into 3 groups: 1st group: complications arising during the stay in hospital (110); 2nd group: complications arising after discharge from hospital and discovered by the patient (239); 3rd group: complications found casually during outpatients' check-ups (6). Of the complications found after discharge, 97% belong to the second group and only 3% to the third group. 657 substituted pacemakers have also been taken into consideration with the purpose of finding out the parameters which showed up as the battery was running down. Out of 145 pacemakers substituted because of flat batteries, 130 (90%) have shown brusque variations in the frequency of stimulation, while only 15 (10%) have shown variations in other parameters (width, length of impulse, etc). The Authors therefore retain that a periodic outpatients' check-up of the pacemakers is of little use as regards the patients' safety and the complete utilization of the device, while they advise that the patient be educated so as to be able to carry out his own daily control of the pacemaker.
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We have studied 20 cases Wenckebach A-V block by atrial pacing. The relationships between conduction time and recovery time of N. AV Wenckebach point, basal A-H time and A-H time of first cycle beat were analysed. No correlation was found between W point, basal A-H and A-H of the first beat by analysing the A-H = f (H-A) we found different curves which occur when the first A-H is longer or shorter than 110. These data were discussed on the basis of modern hypotheses of electrophysiological mechanism of Wenckebach periodism.