BACKGROUND: One third of chronic heart failure patients have major intraventricular conduction and uncoordinated ventricular contraction. Non-controlled studies suggest that biventricular pacing may improve haemodynamics and well-being by reducing ventricular asynchrony. The aim of this trial was to assess the clinical efficacy and safety of this new therapy in patients ...

The presence, frequency, and duration of episodes of paroxysmal atrial fibrillation (PAF) is difficult to establish. This is caused by the limited duration of standard Holter recordings and to the unsatisfactory yield of patient-triggered event recorders, because of asymptomatic events and of an inconsistent use of the patient dependent triggering ...

With advancing age, atrial fibrillation is increasingly likely to indicate underlying cardiovascular disease and risk. An understanding of this is particularly important in the elderly patient, where likely triggers to atrial fibrillation and the influence of other pathologies on the safety and efficacy of proposed treatments will all contribute to ...

Simultaneous dual-isotope (rest thallium-201/stress technetium-99m sestamibi) myocardial single-photon emission tomography (SPET) would be an ideal procedure; however, (99m)Tc cross-talk on the (201)Tl window hampers its routine use. Photon energy recovery (PER) is a spectral deconvolution technique validated for scatter and cross-talk removal in phantom studies and a limited series of ...

Transesophageal echocardiographic (TEE) guidance of cardioversion in patients with atrial fibrillation is an alternative method to conventional anticoagulation. Although TEE is considered the gold standard for excluding left atrial (LA) thrombi, in some patients dense spontaneous echo contrast (SEC) and artifacts may hamper the identification or exclusion of LA thrombi. ...

Treatment of patients with chronic idiopathic urticaria (CIU) involves reducing symptoms with the least invasive therapy and carefully balancing risk and benefit. The mainstay of therapy is the use of antihistamines with or without the use of intermittent pulses of corticosteroids. Alternative therapies to chronic corticosteroids include leukotriene antagonists, plasma-phoresis, ...

BACKGROUND: Controversy exists as to whether secundum atrial septal defects (ASDs) in asymptomatic or mildly symptomatic New York Heart Association (NYHA) class I or II adult patients should be closed. METHODS AND RESULTS: Thirty-seven patients (24 females; mean age 49.4 years, range 19 to 76) with a mean pulmonary to ...

INTRODUCTION: Paroxysmal atrial fibrillation (PAF) frequently occurs in patients with Wolff-Parkinson-White (WPW) syndrome. Catheter ablation of the accessory pathway eliminates PAF in some patients, but PAF frequently recurs in other patients. The present study was designed to determine prospectively whether P wave signal-averaged electrocardiography (P-SAECG) predicts the recurrence of PAF ...

OBJECTIVES: The purpose of this study was to characterize variations in flutter-wave (F-wave) morphology among patients with clockwise isthmus-dependent (CWID) and counterclockwise isthmus-dependent (CCWID) right atrial flutter (AFL) and to attempt to correlate F-wave morphology with echocardiographic data and clinical patient characteristics. BACKGROUND: Variations in F-wave morphology on surface electrocardiogram ...

BACKGROUND: Audit is an important tool in clinical governance. Combining resources from across a region may facilitate data collection and allow variation in practice between individual units to be analysed. This audit is the first such regional audit to be carried out in rheumatology in the West Midlands and the ...

INTRODUCTION: Striated myocardial connections between the venous wall of the coronary sinus (CS) and the left atrium have been described in humans. This aim of this study was to investigate the conduction properties and potential arrhythmogenicity of CS and left atrial myocardial connections in patients with and patients without paroxysmal ...

Atrial fibrillation, the most common tachyarrhythmia, significantly reduces the quality of life of patients and is associated with 15% of strokes. With the aging of the population, it is beginning to reach epidemic proportions. Guidelines for management of atrial tachyarrhythmias exist but in order to implement them, it needs early ...

OBJECTIVES: To investigate which types of enamel opacity are effectively treated by the microabrasion technique and whether this technique could be used as a diagnostic aid to determine the aetiology of these defects. MATERIALS AND METHOD: Thirty two patients who had enamel opacities affecting both upper central incisors were selected ...

BACKGROUND: Electrographic changes after insect stings have been reported both with and without systemic symptoms. To our knowledge, however, there have been no reported cases of arrhythmias in the maintenance phase of venom or pollen immunotherapy. OBJECTIVE: We report a case of a patient who developed paroxysmal atrial fibrillation after ...

BACKGROUND AND AIMS OF THE STUDY: Left atrial (LA) and/or left atrial appendage (LAA) thrombi are often found in patients with rheumatic mitral stenosis (MS). The fate of these thrombi on optimal oral anticoagulation, and the feasibility of balloon mitral valvulotomy (BMV) is not well established. The study aims were ...

BACKGROUND: The conduction system in right atrial isomerism may be complicated by the presence of paired sinus nodes and twin atrioventricular nodes. With a large cohort of infants and children with right atrial isomerism, we sought to investigate the nature of atrial rhythm, its prevalence, factors predisposing patients to symptomatic ...

Recently, intraoperative radiofrequency ablation of the left atrium combined with mitral valve surgery has become widely used. In our center, 30 patients underwent this combined procedure; median sternotomy was used in 16 patients, and port access was used in 14 patients. At hospital discharge, 18 patients (60%) were no longer ...

BACKGROUND: Verapamil and ibutilide blunt the atrial fibrillation-induced shortening of atrial refractoriness that may predispose to an immediate recurrence of atrial fibrillation after cardioversion. This study compared the efficacy of verapamil and ibutilide in preventing an immediate recurrence of atrial fibrillation. METHODS AND RESULTS: Transthoracic cardioversion was performed in 223 ...

OBJECTIVES: The goal of this study was to identify factors associated with radiofrequency catheter ablation (RFCA) outcomes of intra-atrial re-entrant tachycardia (IART). BACKGROUND: Radiofrequency catheter ablation of IART is difficult. The influence of patient and procedural factors and novel technologies on outcomes is unknown. METHODS: Acute and chronic RFCA outcomes ...

BACKGROUND: Although anticoagulation therapy is accepted for most patients with atrial fibrillation, 2 different strategies exist for management of the cardiac rhythm: atrial fibrillation is allowed to persist while the ventricular rate is controlled; and atrial fibrillation is converted, and an attempt is made to maintain sinus rhythm. METHODS: The ...

OBJECTIVE: To evaluate whether ibutilide can convert atrial fibrillation or flutter in patients in whom amiodarone has failed. DESIGN AND SETTING: Clinical study in a university hospital intensive care unit (ICU). PATIENTS: Twenty-six patients were studied, in whom atrial fibrillation or flutter persisted for a maximum of 6 h at ...

It is unknown, whether direct guidance by ultrasound is essential for the safety and efficacy of ultrasound-guided compression repair (UGCR) of pseudoaneurysms. We therefore tested, whether clinically guided manual compression repair (MCR) without continuous ultrasound control may represent an equally effective alternative. After ultrasound diagnosis of a pseudoaneurysm, direct manual ...

BACKGROUND: Left atrial macroreentrant tachycardia (LAMRT) has not been characterized in detail. METHODS AND RESULTS: Twenty-eight patients with LAMRT, including 4 patients with ablated typical atrial flutter (AFL), underwent electroanatomic mapping of the left atrium (LA) between February 1999 and October 2001. LA maps were performed during LAMRT in 26 ...

Episodes of atrial fibrillation occur in patients with WPW syndrome but frequently disappear after successful radiofrequency ablation. AIMS: To analyze the incidence of atrial fibrillation before and after successful ablation and the presence of increased atrial vulnerability. METHODS AND RESULTS: Fifty-four of 183 WPW patients had at least one documented ...

BACKGROUND: Warfarin sodium (warfarin) is commonly prescribed in surgical practice. Warfarin use is complicated by an unpredictable dose response that may be due in part to genetically determined differences in metabolic capacity. To better understand the interaction between genotype and response to warfarin therapy, we determined the frequency and functional ...

AIMS: To analyse whether the proportion of patients with lone atrial fibrillation engaged in chronic sport practice was higher than that observed in the general population. METHODS AND RESULTS: The records of 1160 patients, seen at the arrhythmia outpatient clinic, were reviewed. A total of 70 patients (6%) suffered lone ...

BACKGROUND: To evaluate the validity of normothermic cardiopulmonary bypass (CPB) associated with topical hypothermia and cold cardioplegia technique. METHODS: In a clinical prospective trial, a consecutive series of 100 patients, homogeneous for demographics, clinical and operative data, undergoing coronary artery bypass surgery were randomized for hypothermic CPB (rectal temperature 28-32 ...

OBJECTIVES: Supraventricular arrhythmias are one of the most common and fatal sequelae of the Fontan operation. P wave triggered signal averaged electrocardiography was performed in patients undergoing the Fontan operation to evaluate the presence of atrial degeneration, and to clarify which factors affected the development of atrial arrhythmias. METHODS: P ...

BACKGROUND: Tele-echocardiography has the potential to bring real-time diagnoses to neonatal facilities without in-house pediatric cardiologists. Many neonates in rural areas, smaller cities, and community hospitals do not have immediate access to pediatric sonographers or echocardiogram interpretation by pediatric cardiologists. This can result in suboptimal echocardiogram quality, delay in initiation ...

BACKGROUND: This review examines the surgical management of acute superior mesenteric artery (SMA) occlusion and the impact of interventional radiology techniques. METHODS: Eight consecutive patients with SMA occlusion were treated at the Lismore Base Hospital, Lismore, NSW, Australia, from 1996 through to 2001 and of these, one patient was managed ...

We describe a patient with an intact spleen and moderately severe symptoms of Gaucher disease in whom, after initiation of (low-dose) enzyme replacement therapy (ERT), thrombocytosis (720 x 10(9)/l) was documented. Checking the International Gaucher Registry database revealed that this patient is the only nonsplenectomized patient of more than 1,000 ...

INTRODUCTION: Atrial flutter is a common sustained atrial tachyarrhythmia for which frequency increases with age. Ibutilide is a novel class III antiarrhythmic agent used for the rapid cardioversion of atrial fibrillation or atrial flutter. AIM: The aim of our study was to assess the use of ibutilide in a selected ...

OBJECTIVES: The effectiveness of oral quinidine for conversion of atrial fibrillation to sinus rhythm was evaluated in 49 patients with persistent atrial fibrillation on anticoagulation therapy. Atrial fibrillation was considered as persistent when the duration was longer than 3 days but less than 6 months. METHODS: Patients received orally one ...

BACKGROUND: We studied the prevalence of atrial fibrillation within a large Italian inpatient population, and evaluated the use of antithrombotic therapy among these individuals. METHODS: A prospective cross sectional study (Phase 1) with a 1-year follow-up period (Phase 2) was conducted at a single Italian centre. During Phase 1, we ...

BACKGROUND: Paroxysmal atrial fibrillation is associated with various symptoms, including dizziness, which presumably reflects hemodynamic deterioration. Given the importance of the autonomic nervous system in mitigating the hemodynamic effect of atrial fibrillation, we hypothesized that autonomic function would be predictive of the severity of dizziness. METHODS: The study group comprised ...

INTRODUCTION: This study evaluated the safety and efficacy of a new dual-chamber implantable cardioverter defibrillator (ICD) to detect and treat atrial tachyarrhythmias in patients with drug-refractory atrial fibrillation (AF) and no indication for a ventricular ICD. METHODS AND RESULTS: A dual-chamber ICD (Medtronic 7250 Jewel AF) was implanted in 144 ...

OBJECTIVE: The objectives were to study atrial and ventricular electromechanical function in patients long after Mustard repair for transposition of great arteries and to identify possible causes and physiologic disturbances in those with recurrent atrial flutter. METHODS: Electromechanical atrial and ventricular function was assessed in 22 patients (11 women) aged ...

BACKGROUND: The ostium of the superior pulmonary veins or superior vena cava has been reported to be an important source of the ectopic beats that initiate paroxysmal atrial fibrillation (PAF). The structural details of the atria in patients with idiopathic PAF, however, remain unknown. METHODS: We studied 113 patients (92 ...

BACKGROUND: Paroxysmal atrial fibrillation (PAF), a common arrhythmia, is caused by the fractionated and nonhomogeneous propagation of sinus impulse. HYPOTHESIS: This study was undertaken to examine the effect of left atrial (LA) dimension and function on P-wave dispersion (deltaP) in unselected patients with PAF and health controls. METHOD: In this ...

The purpose of this study was to determine whether parameters derived from transesophageal echocardiography (TEE) could predict thromboembolism in patients with chronic nonvalvular atrial fibrillation (AF). Eighty-nine patients, mean age 66+/-9 years, who underwent TEE in 1996 to 1999 were studied. The clinical endpoint was a thromboembolic event, including transient ...

AIMS: To assess compliance to guidelines in the management of patients with atrial fibrillation. METHODS AND RESULTS: A total of 728 questionnaires were mailed to physicians with the intention of studying 'theoretical' compliance to practice guidelines. A retrospective evaluation of 200 records from consecutive patients hospitalized with atrial fibrillation was ...

BACKGROUND: In adults with atrial septal defect (ASD) and large right-to-left shunt, closure of the defect is recommended. Percutaneous closure is still rarely used in this population. This study presents the results of transcatheter closure with the Amplatzer occluder in such patients. METHODS AND RESULTS: We studied 44 consecutive adult ...

OBJECTIVES: The study was done to assess the prevalence of left atrial (LA) chamber and appendage thrombi in patients with atrial flutter (AFl) scheduled for electrophysiologic study (EPS), to evaluate the prevalence of thromboembolic complications after transesophageal echocardiographic (TEE)-guided restoration of sinus rhythm and to evaluate clinical risk factors for ...

BACKGROUND: Nocturia is one of the major problems of elderly people. The possible causes of nocturia include irritation of lower urinary tract obstruction, disturbance of the fluid balance, and sleep disturbance. In a significant proportion of patients, the mechanism of nocturia is still unclear and a definitive method of treatment ...

OBJECTIVE: To assess the changes in quality of life, arrhythmia symptoms, and hospital resource utilisation following catheter ablation of typical atrial flutter. DESIGN: Patient questionnaire to compare the time interval following ablation with a similar time interval before ablation. SETTING: Tertiary referral centre. PATIENTS: 63 consecutive patients were studied. Four ...

BACKGROUND: Interatrial block (IAB: P wave > or = 110 ms) is a strong correlate of left atrial (LA) enlargement and an important predictor of supraventricular tachyarrhythmias, notably atrial fibrillation and flutter. It is surprising that, despite its association with arrhythmias and its effects on the electromechanical properties of the ...

OBJECTIVES: The purpose of the study was to look for the predictor factors of atrial proarrhythmic effects of class I antiarrhythmic drugs. BACKGROUND: Class I antiarrhythmic drugs may induce or exacerbate cardiac arrhythmias. The predictors of ventricular proarrhythmia are known. The predictors of atrial flutter with 1:1 conduction are unknown. ...

STUDY OBJECTIVE: Chest pain in the setting of cocaine use poses a diagnostic dilemma. Dobutamine stress echocardiography (DSE) is a widely available and sensitive test for evaluating cardiac ischemia. Because of the theoretical concern regarding administration of dobutamine in the setting of cocaine use, we conducted a pilot study to ...

The aim of the study was to assess the morphology of secundum-type atrial septal defects (ASD) with a view to percutaneous closure using Amplatzer septal occluders (ASO). One hundred and ninety patients who underwent closure of isolated secundum-type ASD between September 1995 and January 2000 were included. The morphology of ...

INTRODUCTION: Atrial activity on the surface ECG during premature beats and supraventricular arrhythmias frequently is obscured by the superimposed QRST complex of the previous cardiac cycle. This study examines the performance of a newly developed automatic QRST subtraction algorithm to isolate ectopic P waves from the preceding T-U wave. METHODS ...