The prevalence of clinical and electrophysiological signs of peripheral nerve disease was evaluated in 151 patients with chronic obstructive pulmonary disease. Patients with concomitant disorders affecting the peripheral nervous system were excluded. Thirty patients had clinical signs of a mild sensorimotor and distal neuropathy and 13 additional patients had only electrophysiological abnormalities. The rate and the severity of the neuropathy correlated with the severity of chronic hypoxaemia. Three out of 20 patients with mild hypoxaemia (PaO2 less than 15 mm Hg below normal) had polyneuropathy as compared with 15 out of 36 with severe hypoxaemia (PaO2 more than 30 mm Hg below normal (rates different at the 10% level)). PaO2 and age were the only variables discriminating between patients with and without peripheral neuropathy.
Programmed electrical stimulation was performed in 54 consecutive patients with hypertrophic cardiomyopathy. There were 11 'symptomatic' patients: three had a history of cardiac arrest due to ventricular tachyarrhythmias (group A), and eight had a history of syncope of unknown origin (group B); 43 patients were 'asymptomatic', i.e. they had no documented or suspected symptomatic ventricular arrhythmias (group C). There were no differences among the groups with respect to electrocardiographic, echocardiographic or hemodynamic data. Ventricular arrhythmias were induced by atrial and right and left ventricular stimulation with a maximum of two extrastimuli in 18 patients. Induced arrhythmias were repetitive ventricular response in six patients, nonsustained ventricular tachycardia in four, sustained ventricular tachycardia in five, and ventricular fibrillation in three patients. With one exception, ventricular tachycardia was always rapid (cycle lengths ranged from 180 to 250 ms); it was polymorphic in six patients and monomorphic in three. Atrial stimulation induced rapid monomorphic ventricular tachycardia in one group A patient. The type and incidence of induced ventricular arrhythmias did not differ among the three groups. It is concluded that programmed electrical stimulation induces the same type of ventricular arrhythmia (rapid polymorphic ventricular tachycardia or ventricular fibrillation) in 'symptomatic' and 'asymptomatic' patients with hypertrophic cardiomyopathy, the incidence in the latter group being 19%. Induction by atrial stimulation of a rapid ventricular tachycardia may be a specific finding to identify patients with hypertrophic cardiomyopathy at risk for exercise-induced ventricular fibrillation.
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