[Controversial aspects of cardiac electrostimulation in conduction disorders].
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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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A 22-year-old woman had exertional chest pain and dyspnea secondary to left ventricular outflow tract obstruction more than a decade after repair of a type I double-outlet right ventricle. The obstruction was the result of (1) failure of the ventricular septal defect and the tunnel created between the left ventricle and aorta to enlarge commensurate with growth of the heart and (2) a markedly hypertrophied parietal band of the crista supraventricularis which surrounded and narrowed the aortic orifice. At reoperation, the ventricular septal defect and the tunnel were enlarged and the hypertrophied crista supraventricularis was partially resected. The patient is asymptomatic 6 months after operation.
Acceleration Bcgs were recorded on 22 subjects at rest and during acute elevation of blood pressure produced by isometric grip. Measurements on computer averaged graphic waveforms of H/I slope, I/J slope and I-J amplitude were made. The ratios of values during stress, to resting state, helped to select patients with 1,2 or 3 declines of 10% or more from the resting values. The method has the advantage of using each subject as his own control, and may help to elicit varying grades of myocardial pumping dysfunction not evident at rest.
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A report is made on the experience gained in more than 600 cardiac catheterizations using the Swan-Ganz-Intracardiac floating catheter. This procedure is an addition to the diagnostic possibilities and provides answers to cardiological and pulmonological questioning which, so far, had not been an indication for cardiac catheterism. Its advantage is the safety of application and little inconvenience to the patient with a high information content for the physician. If the investigations are carried out under ergometer load, new aspects of functional diagnostics arise with respect to problems requiring intimate knowledge of the myocardial function.
Aneurysms of Valvsalva sinus unruptured into a cavity, but developing into the membranous and even muscular interventricular septum are exceptional. Two cases illustrating this fact are reported. In one of them, a massive mitral incompetence by elongated chordae tendinae related to the presence of a voluminous intra-septal pouch. Atrio-ventricular and intraventricular conduction disturbances were present in both patients. The interest of supra-valvar angiography which makes it possible to advise operation before the eventual rupture is underlined.
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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.
Electrophysiological changes produced by intravenous (0.1 mg/kg) metoprolol, a new selective beta 1-blocking agent devoid of intrinsic activity, were studied in 16 subjects with estimated normal impulse formation and conduction. The most important effects were sinus bradycardia, mild increase of sinoatrial conduction time, depression of intranodal conduction, and prolongation of AV node refractory periods. Sinus node recovery time and atrial refractory periods were unmodified. Infranodal conduction and the refractory periods of the His-Purkinje system, as well as of the bundle-branches, were unchanged. These effects are compared with those observed after intravenous propranolol, pindolol, and oxprenolol.
An unusual patient is described in whom electrophysiological studies strongly suggest the occurrence of Mahaim conduction. The patient whose electrocardiogram previously showed a left anterior hemiblock pattern then developed advanced atrioventricular (AV) block (AH block). Beats conducted through the atrioventricular node always had a short HV interval (20 ms) and QRS complexes of left anterior hemiblock pattern. Junctional escape beats always had a normal HV interval (50 ms) with normal intraventricular conduction. His bundle pacing showed the StV interval and QRS contour of escape beats. These findings suggest the existence of an accessory pathway (Mahaim fibres) passing from the area of block, presumably the uppermost portion of the His bundle, to the posteroinferior division of the left bundle-branch. The surface electrocardiogram did not show the characteristic delta wave of the Wolff-Parkinson-White syndrome. Our observations suggest that patients in whom there is conduction along Mahaim fibres may show only the pattern of intraventricular conduction defect without a delta wave.