BACKGROUND Torsade de pointes is characterized not only by its particular ECG pattern but by its context of congenital or acquired long QT syndrome and the long coupling interval of the initial premature beat. METHODS AND RESULTS We observed 14 patients aged 34.6 +/- 10 years (mean +/- SD) with no structural heart disease who presented with syncope related to a typical ECG aspect of torsade de pointes. However, there was no evidence of long QT syndrome, and the torsade had the unusual particularity of an extremely short coupling interval of the first beat or of the isolated premature beats (245 +/- 28 milliseconds). In 10 cases they deteriorated into ventricular fibrillation. Four patients had a familial history of sudden death. Only 2 patients had a tachyarrhythmia inducible by programmed stimulation. At Holter recordings the heart rate variability was globally and significantly depressed, the vagal limb of the autonomic nervous system being predominantly affected. During a mean follow-up of 7 years there were 5 deaths (4 sudden). Nine patients are alive, 3 with implanted defibrillators and 6 treated with verapamil alone. Unlike the other types of antiarrhythmic agents including beta-blockers and amiodarone, verapamil is in our experience the only drug apparently active on the arrhythmias; however, it does not prevent sudden death. CONCLUSIONS The short-coupled variant of torsade de pointes should be identified because of their ECG pattern and the risk of sudden death in young adults with no structural heart disease.
SummaryBackground: Relationships between heart rate (HR) variability and different prognostic markers such as ejection fraction. functional capacity, and patency of the infarct-related artery, as well as the comparison of their time courses are not fully elucidated.Hypothesis: The aim of study wa5 to assess prospectively the early postinfarction changes in HR variability and its evolution over a period of 6 months; the relationships between HR variability and functional capacity in exercise testing; left ventricular function in cardiac catheterization; status of the infarct-related artery; and the comparison of their time courses.Methotis: In 42 patients with anterior myocardial infarction. a study was made of the early changes in HR variability analyzed by the complex demodulation method, its evolution over a period of 6 months, and the relationships between HR variability and ( 1) functional capacity in exercise testing, ( 2 ) left ventricular function in cardiac catheterization, and (3) status of the infarct-related artery.Results: At 1 week HR variability parameters correlated directly with functional capacity indicators such as METS, percent change in HR from rest to peak exercise (%AHR), difference between initial and peak HR (HR range), percent peak
The aim of this study was to determine whether the spatial limitation of the inhibitory effect of subthreshold conditioning stimuli trains (TSc) could be overcome by their simultaneous emission through several electrodes surrounding the area where the suprathreshold extrastimuli (S2) are delivered. In seven anesthaetized open chest dogs the effective ventricular refractory period was determined before and after the introduction of unipolar cathodal TSc, using epicardial electrodes. TSc pulse frequencies tested were 100 Hz, 200 Hz, 400 Hz, 600 Hz and 800 Hz, and train intensity was 10% lower than the train diastolic threshold for every pulse frequency. S2 and TSc were delivered: (a) by the same electrode; (b) by two different electrodes 3 mm apart; and (c) TSc through six peripheral electrodes surrounding the central electrode that delivered S2 (heptapolar electrode). Trains of 400 Hz showed the highest diastolic threshold, permitting the use of the highest train intensities. When TSc and S2 were delivered through the same electrode the ventricle remained unexcitable during the entire cardiac cycle in six of the seven dogs. In turn, when TSc and S2 were delivered by two different electrodes, the effective ventricular refractory period (EVRP) could only be increased by greater than or equal to 10 ms in three of the seven dogs (18 ms, 62 ms and 10 ms). When TSc was delivered simultaneously through six peripheral electrodes the increments were higher (118 ms, 88 ms and 75 ms) in these three dogs, and there was one additional dog with 12 ms increments of of EVRP.(ABSTRACT TRUNCATED AT 250 WORDS)
Subthreshold stimuli trains may inhibit the response to a subsequent suprathreshold stimulus; the inhibitory effect decreases or even disappears when the subthreshold stimuli are delivered apart from the suprathreshold stimulus. The purpose of this study is to analyse, in atrial epicardium, the influence of different electrode configurations upon the inhibitory effect of subthreshold stimuli trains delivered at a short distance from the explored zone. In 18 anaesthetized dogs, the basal atrial effective refractory period was determined using an epicardial unipolar cathodal electrode. A second determination was performed when a subthreshold stimuli train (1 ms cathodal pulses, 800 Hz, and intensity 10% less than the diastolic threshold of the train) was delivered prior to the extrastimulus through: (a) 8 electrodes equidistant (4.5 mm) from the central test electrode (Group 1, n = 5); (b) a 1 mm wide ring electrode, 2.5 mm from the central test electrode (Group 2, n = 7); and (c) a 3.5 mm wide ring electrode, 2.5 mm from the central test electrode (Group 3, n = 6). A third determination was performed in all experiments delivering both the subthreshold stimuli train and the extrastimulus through the same central test electrode. Atrial effective refractory period did not vary significantly with respect to the basal values in Group 1 (141 +/- 22 vs 142 +/- 25 ms; ns) though it increased in Group 2 (168 +/- 27 vs 142 +/- 18 ms; P < 0.01) and in Group 3 (160 +/- 20 vs 133 +/- 25 ms; P < 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)
Sinus node ablation by high-frequency current (HFC) (0.7 MHz. 5-10 W), delivered through the distal electrode of a conventional endocavitary catheter, was induced in seven thoracotomized dogs under autonomic blockade. The HFC was delivered for variable periods of time under ECG monitoring, while sinus tachycardia was produced or after attaining sinus arrest. The procedure was repeated until a stable non-sinus rhythm was obtained. Sinus rhythm was abolished in all seven dogs after a variable number (7-20) of discharges. The escape rhythm obtained after the last discharge, characterized by means of epicardial electrodes and analysis of P-wave morphology, length of PR interval and the rate, showed an atrial activation pattern different from sinus rhythm in all cases. The P-wave was retrograde in two cases, and in one case no atrial activity was detected after the last discharge; however, atrial activity recovered after 35 min, the activation pattern being different from the controls. After 2 h, sinus rhythm had not returned in any case. In no case was there perforation of the atrial wall. Acute histological findings showed coagulation necrosis of the endocardium, extending to the muscle fibres and affecting the sinus cells.
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