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Biomedical subjects

M Scherillo

Publications and source records attributed to M Scherillo.

26 records · Page 2Linked to original sources
PubMed1986

Transvenous catheter ablation of the His bundle in ventricular tachycardia.

The usefulness of transvenous catheter ablation of the His bundle in three patients with recurrent ventricular tachycardia (VT), in which the initiating mechanism was recognized during a rapid atrial rhythm, is reported. Tachycardia was refractory to conventional treatment and required transthoracic direct-current shocks in all patients. In patient No. 1 double tachycardia (atrial flutter and VT) was documented and VT was easily induced by rapid atrial pacing. In patients Nos. 2 and 3 initiation of VT during junctional reciprocating and atrial tachycardia, respectively, was observed. Interruption of the His bundle was performed by means of fulguration. Stable atrioventricular (AV) block was observed in patient No. 1 after the ablative procedure; patient No. 2 showed anterograde conduction over a posterior septal accessory pathway with no evidence of conduction over the normal conduction system in both the anterograde and retrograde directions. In patient No. 3, transient AV block was observed; AV conduction resumed 2 days later and the cardiac rhythm showed persistent ectopic atrial tachycardia with second-degree AV block. Patients Nos. 1 and 2 underwent pacemaker implantation, but patient No. 2 was not pacemaker dependent. After the procedure, VT no longer occurred in any of the patients (follow-up: 2 years, 5 months, and 6 months).

Aged↗
PubMed1985

Catheter ablation of accessory pathway in the permanent form of junctional reciprocating tachycardia.

Successful transvenous catheter ablation of accessory pathway (AP) in a patient (pt) with the permanent form of junctional reciprocating tachycardia is reported. A concealed AP with long conduction time comprised the retrograde limb of tachycardia circuit. The atrial end of the AP was near the coronary sinus (CS) orifice. Catheter ablative technique was performed after assessment of its feasibility and safety by using a canine model. During an electrophysiologic study CS mapping was obtained; the earliest retrograde activity was recorded 1-2 cm inside the orifice of the CS. Two unipolar shocks of 120 J were delivered on the sites exhibiting the earliest retrograde atrial activity. After the procedure, the AP was no longer conducting in both anterograde and retrograde direction. During a follow-up period of 13 months, the pt remained free of tachycardia on no antiarrhythmic medication.

Adult↗
PubMed1984

Anatomic and electrophysiologic substrate of the permanent form of junctional reciprocating tachycardia.

Data are reported on three patients with the permanent form of junctional reciprocating tachycardia, in whom conduction over a slow accessory pathway was observed after His bundle ablation. Tachycardia was almost incessant and showed a retrograde P wave (P') and RP' interval longer than P'R interval in all patients; during sinus rhythm, the PR interval was normal and there was no evidence of a delta wave. An accessory pathway with a long conduction time located in the posterior pyramidal space provided the retrograde limb of the reentry circuit. After His bundle ablation, the accessory pathway was capable of conducting in both anterograde and retrograde directions with decremental properties in all patients. Postmortem documentation of the accessory pathway was achieved in one patient. Serial sections revealed an accessory atrioventricular connection composed of ordinary myocardium joining the lower rim of the coronary sinus outlet to the uppermost ventricular muscle. This anomalous atrioventricular connection pursued a sinuous, tortuous path. As a result of changing cross-sectional area, such an accessory pathway might exhibit slow conduction, thus explaining its decremental characteristics.

Adolescent↗
PubMed1984

[Closed-chest interruption of abnormal bundles of His. Its use in a case of "incessant" tachycardia guided by an experimental model].

The usefulness and safety of intracardiac discharge of a synchronized DC shock through a catheter-electrode to ablate the His bundle has led the Authors to evaluate the use of this technique to interrupt bypass tracts located near the coronary sinus. Acute experiments were performed in 10 open chest dogs. A tripolar 6F catheter-electrode was placed in the coronary sinus and 2 or 3 unipolar shocks of 80-120 joules were delivered to each electrode. After the procedure the coronary sulcus was inspected and a lesion 2-3 cm wide and 2-4 mm deep with edema and haemorrhage was found in all cases. On the basis of the data obtained in dogs, the technique was successfully used in a woman with "incessant" supraventricular tachycardia due to reentry through a concealed anomalous pathway located in the posterior septum. A careful mapping of the coronary sinus allowed the localization of the earliest retrograde atrial activation. Two shocks of 120 joules were delivered in the coronary sinus at the site suggested by the electrophysiologic mapping. The patient has remained free from tachycardia since the time of the discharge (follow-up: three weeks).

Adult↗
PubMedDate not supplied

[Management programs for elderly patients with chronic heart failure].

PURPOSE: Most patients with heart failure are elderly with multiple coexisting diseases and heart failure is the most common discharge diagnosis in elderly hospitalized patients. Despite major advances in the pharmacotherapy of heart failure, hospitalization rates remain high, owing in large part to a multitude of psychosocial, behavioral, and financial factors that serve as barriers to effective compliance with prescribed treatment. In the last decade, several models have been proposed in order to optimise the long-term management of elderly patients with heart failure. DESIGN: A review of most significant and recent models available was performed. RESULTS: Several studies have documented the efficacy of specialized multidisciplinary heart failure disease management programs in terms of reducing hospital utilization, improving quality of life, functional capacity, patient satisfaction, compliance with diet and medications and decreasing cost of care. CONCLUSIONS: At present, the greatest challenge in managing elderly heart failure patients is to more effectively implement proven treatments and disease management systems.

Age Factors↗