Accelerated allograft coronary artery disease remains the major cause of mortality after the first year of transplantation. Despite the extensive use of stents and angioplasty in coronary artery disease, there is a paucity of data about the efficacy of such interventions in orthotopic heart transplants. The authors herein report the outcome of those patients in their institution who had undergone percutaneous coronary artery angioplasty and stenting at a late stage of their transplantation. Within a 12-year period, 106 adult patients underwent orthotopic heart transplantation at their institution. Eight of these patients with 17 lesions underwent deployment of nine stents and eight angioplasties 8.1 +/- 3.2 years posttransplantation. There were 15 denovo and two restenotic lesions. The indications for intervention were presence of symptoms in five patients and severity of lesions in three asymptomatic patients detected on their follow-up angiogram. All patients had angiographic worsening of lesions at their follow-up angiogram. The initial procedural success for both stented and angioplastied lesions was 100%. Within a mean angiographic follow-up of 261 days, all balloon angioplastied lesions had developed restenosis, whereas within a mean period of 67 days, 50% of stented lesions had developed restenosis. On the follow-up angiogram, deterioration of the nontreated segments were noted throughout the coronary arterial tree; however, the immediate proximal and distal parts of the target segments demonstrated an exaggerated hyperproliferative response as compared to other sites. The overall median time to the detection of restenosis for both stented and angioplastied lesions was 5.2 months (inner quartile 2.5-6.2 months). The authors conclude that angioplasty and stenting late in the course of transplantation is associated with a significant restenosis rate and in such patients earlier or alternative catheter-based interventions must be considered.
We report a case of 78-year-old man admitted to the hospital due to palpitations and lightheadedness. On EKG advanced atrioventricular block with ventricular rate of 37 beats per minute was noted. On electrophysiology study a common type of atrioventricular nodal reentrant tachycardia was inducible with maintenance of advanced AV block. Radiofrequency ablation of slow pathway followed by placement of a permanent pacemaker resulted in elimination of tachycardia and resolution of symptoms.
BackgroundAdministration of aldosterone antagonists among patients with congestive heart failure (CHF) reduces total mortality, sudden cardiac death and frequency of ventricular arrhythmias. Effectiveness of spironolactone, an aldosterone antagonist, in reduction of implantable cardiovertor-defibrillator (ICD) shocks due to ventricular arrhythmia among patients with CHF has never been established. We sought to establish that spironolactone reduces the frequency of total ICD shocks, ventricular tachycardia (VT), ventricular fibrillation (VF) and non-sustained VT (NSVT).MethodsAll patients who underwent ICD implantation between 2000 and 2002 and were receiving spironolactone due to CHF were compared with matched group of control subjects with CHF and ICD, who were not receiving spironolactone. Kruskal-Wallis test was performed for the means of ICD shocks, number of VT, VF and NSVT episodes per month, in the study and control group. P value was calculated for each variable.ResultsBaseline characteristics were similar in the treatment and control groups: age (64.61 vs. 67.54 yrs; p = 0.29), LVEF (21.3% vs. 24.7%; p = 0.06), CAD (82.1% vs. 94%; p = 0.22), use of beta blockers (85.7% vs. 63.8%, p = 0.08), amiodarone (21.43% vs. 30.56%, p = 0.56) and ACE inhibitors (75% vs. 61.1%, p = 0.29) respectively. The results are given in the Table: ConclusionsSpironolactone reduced the frequency of total ICD shocks, VT and NSVT but not VF among ICD recipients with CHF.
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