[Myocardial contractility and motility in patients with artificial cardiac pacemakers. Echocardiographic study].
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A case is presented in which first-degree block in all three fascicles of the intraventricular conduction system results in a QRS complex with no specific features of fascicular block. During spontaneous sinus arrhythmia the typical features of RBBB and LAH appear at the longest sinus cycles. This is associated with shortened P-R and H-Q intervals. During shorter sinus cycles, near equalization of delay in each fascicle is associated with delay in His-Purkinje conduction but loss of the typical features of bifascicular block as the ventricular myocardium becomes activated more synchronously. Documentation of the changing patterns of ventricular activation is provided by His bundle electrocardiography.
All 588 aortocoronary bypass operations performed in the community hospitals of greater New Orleans before 1974 are reported. Hospital mortality averaged 8.7% (4.3% for one bypass; 6.4% for two; 10.3% for three or more; 26% when bypass was combined with another cardiac procedure). Mortality ranged from 5% to 31% among ten surgical groups and from 0 to 20% among seven community hospitals. Men over 60 had excessive mortality (25%). The incidence of major nonfatal complications (myocardial infarction in 12.8% of patients, intraventricular conduction defects in 9.6%, significant arrhythmias in 10.7%, and complications requiring reoperation in 9.5%) also varied with the surgical group, the complexity of the procedure, the patient's age, and the hospital. As determined by these four factors, results of bypass operations in the community hospitals of greater New Orleans ranged from excellent to poor.
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A review and discussion of the incidence and clinical importance of various cardiac arrhythmias in patients with inflammatory diseases of the heart is presented in this paper.
The authors report on 4 Intensive Care Unit cases, hospitalized for syncopes due to serious ventricular arrhythmias. They all presented long Q-T and were receiving treatment with prenylamine. Improvements were observed on suspension of the drug, suggesting therefore that during this treatment, frequent electrocardiographic checks, especially for elderly patients, should be carried out. Caution should also be exercised in associations with other chinidinosimiles and hypokaliemic drugs
2 patients with symptoms of paroxysmal AV block showed widening, splitting, slurring and decreasing amplitude of the His potential. Concomitantly, this was followed by different patterns of bundle branch block. In one of the patients it was obvious that a left bundle branch block was related to a Wenckebach phenomenon in the His bundle, and in the other patient different bundle branch block patterns were related to the occurrence of the intra-His bundle conduction delay. It is suggested that the present electrophysiological findings reflect asynchronous conduction in the His bundle causing a critical conduction delay in parts of the bundle branches leading to bundle branch block.
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It was established that the presence of Samoilov-Wenckebach's periods and prolongation of the H--V interval at low frequency of the imposed rhythm as well as periods of asystolia of more than 1,200 msec are most typical for these patients. An attempt was made to determine the type of cardiac stimulation indicated for such patients from the character of the disorders of rhythm observed in them and the initial frequency of their own cardiac contractions.
The overdrive pacing method is widely used now in clinical practice for prevention and treatment of severe ventricular disorders of the cardiac rhythm. The mechanisms of arrhythmia suppression by means of this stimulation is analysed. Indications are determined for the choice of the site of stimulation and optimal impulce frequency in ischemic heart disease, and overdosage with digitalis drugs, as well as in myocardiopathy.