Objective-To study the outcome of patients with arrhythmogenic right ventricular dysplasia treated with an implantable cardioverter-defibrillator (ICD) for ventricular tachyarrhythmias complicated by haemodynamic collapse. Design-Observational study. Setting-University hospital. Patients-Nine consecutive patients (eight male, one female; mean (SD) age, 36 (18) years) with arrhythmogenic right ventricular dysplasia presenting with ventricular tachycardia and haemodynamic collapse (n = 6) or ventricular fibrillation (n = 3), treated with an ICD. Main outcome measures-Survival; numbers of and reasons for appropriate and inappropriate ICD interventions. Results-After a mean (SD) follow up of 32 (24) months, all patients were alive. Six patients received a median of 19 (range 2-306) appropriate ICD interventions for events detected in the ventricular tachycardia window; four received a median of 2 (range 1-19) appropriate ICD interventions for events detected in the ventricular fibrillation window. Inappropriate interventions were seen for sinus tachycardia (18 episodes in three patients), atrial fibrillation (three episodes in one patient), and for non-sustained polymorphic ventricular tachycardia (one episode in one patient). Conclusions-Patients with arrhythmogenic right ventricular dysplasia and malignant ventricular arrhythmias have a high recurrence rate requiring appropriate ICD interventions, but they also often have inappropriate interventions. Programming the device is diYcult because this population develops supraventricular and ventricular tachyarrhythmias with similar rates. (Heart 2001;85:53-56)

In Belgium, favourable trends in the prevalence and in the patterns of detection, treatment and control of arterial hypertension and in the levels of systolic blood pressure were observed. The so-called 'rule of halves' is no longer valid.

We report a patient with Parkinson's disease treated with two pectorally implanted neurostimulators (NSs) who presented with a life-threatening ventricular tachyarrhythmia in whom an abdominal ICD was implanted. Testing during implantation showed that the NS did not affect the bipolar sensing of the ICD, even when the NSs were set at a frequency of 130 pulses/s with an output of 5 V and pulse width of 0.21 ms in a bipolar and a unipolar configuration. The ICD shock, however, did affect both NSs: there was a reset to the output Off state and there was a reset of the electrode polarities.

No abstract

Patients with non-rheumatic AF (n-335, age-40-85 years. mean 64+/-42 years; Male 188, Female 147, ware followed up for a mean period of 38±8 months. Palpitation (90%), effort intolerance (82%), angina (60%), heart failure (28%), stroke (15%) and peripheral embolism (5%) were the presenting features. IHD was the commonest aetiology (52%) followed by hypertension (28%), cardiomyopathy (12%), thyrotoxicosis (5%) and lone AF (3%). Age • 65 years, hypertension, transient ischaemtc attacks, diabetes mellitus constituted high dsk group. Chronic AF (54%) was more evident than paroxysmal (24%) and persistent (22%) types Patients with left atrial thrombus (42%) were placed on oral anticoagulants. Incidence of stroke was 0.5% in the anticoagulated groups vs. 15% in controls (p < 0.0001). DC cardiover sion was effective in restoration of sinus rhythm (SR) in 70% cases but maintenance of SR required antiarrhythmic drugs. On average followup of 38+8 months, amiodarone (72%) was found to be superior to quinidine (48%) (p < 0.0001) in relation to maintenance of SR; next to it were digoxin (42%), [(]-blockers (35%), calcium channel blockers (28%). Overall mortality was 4% 40 patients were refractory to drug therapy, 10 of them underwent pacing, 10 underw~ent ablation followed by permanent pacing (DDDR) with mode switching. 70% patients with pacing +/-RF ablation remained symptom-tree and maintained SR for 14+_2 months. In conclusion pacing arm RF ablation in selected cases is superior to pharmacological treatment in symptomatic relief but not in maintenance of SR Drug therapy is the mainstay of treatment for maintenance of SR Aims: Identification of patients at dsk for paroxysmal atdal fibrillation during sinus rhythm has been demonstrated using P wave signal averaged electrocardiography. The predication of PAF however has not been possible due to the presence of Premature Atdal Contraction. The purpose of this study was to test a new computer interface based on a mathematical predictor, for the use of P-Wave SAECG. Methods: An 88 patient (59 M, 59+10) database with at least on e documented episode of PAF, P wave duration on the SAECG, the left atdal diameter and the patient age were collected 24 hours from the last PAF episode. A monthly follow up was performed (3months/pts) for identifying patients with (Group 1, 32 patients) and without (Group 2, 56 patient) PAF recurrence, in order to defne the arrhythmic risk predictor value of P wave duration SAECG. Results:The results were entered via the compute interface with results as shown:Group 1 Group 2 P value Left Atrial diameter (cm) 3.8+5.6 3.7+5.3 0.977 Age (year) 57+11 59+11 0.563 SAECG P wave duration ms 137+14 125+10 0.005 In the discrimination of two groups using the automated predictor , a P wave duration (filtered) > 130 ms showed 73% sensitivity, 76% specifity, 51% positive and 91% negative predictive value. Concluaion: The results indicate the accuracy an automated predictor ol the P wave signal averaged SAECG in identifying patients at risk for the recurrence of atdal...