[Functional type intraventricular conduction disorders. Experimental study with the atrial electrostimulation technic].
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The AA. relate on two cases of pacemaker implantation in childhood, and they outline the causes that make necessary a cardiac pacemaker in such an age and the troubles can possibly occur.
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The electrophysiologic properties of Lorcainide (1.25 and 2.5 mg/kg) were studied on 21 patients by intracardiac electrograms and atrial stimulation. A prolongation of the H-V interval, widening of QRS duration but only minor changes in A-H interval were found. The effective refractory period of the atria increased, the effective and functional refractory periods of the A-V node changed variable following Lorcainide. There was a slight increase in heart rate and the sinus node recovery time was longer after 2.5 mg/kg of the drug. The major site of action of Lorcainide in man appears to be the His-Purkinje system. In electrophysiologic terms the new antiarrhythmic agent closely resembles Aprindine.
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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.
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A case is described where the basic sinus rhythms is associated with an advanced degree of left anterior hemiblock. The rhythm is complicated by atrial extrasystoles, associated with a lesser degree of left anterior hemiblock. This paradox of 'supernormality' is explained on a critical interplay of differential refractoriness within the divisions of the left bundle-branch.