Arrhythmia Surgery Research Articles

Precision of preoperative electrophysiological study in predicting the intraoperatively defined location of single left-sided accessory pathways.

In 34 patients with a left-side anomalous pathway (AP) considered for arrhythmia surgery, the atrial insertion of the anomalous pathway in the preoperative investigation was determined by using three different techniques. The atrial activation sequence during orthodromic tachycardia or ventricular stimulation was recorded in the coronary sinus by using either (a) unipolar leads from an eight-polar electrode catheter with an interelectrode distance of 1 cm, (b) bipolar leads from consecutively positioned pairs of electrodes on the same electrode catheter or (c) bipolar leads recorded at one centimeter intervals by withdrawal of the electrode catheter. The corresponding location at surgery was obtained by atrial epicardial mapping during ventricular stimulation. Each way of recording the atrial activation sequence in the coronary sinus during orthodromic tachycardia or ventricular stimulation was compared with regard to their predictive value in assessing the corresponding location by intraoperative mapping. At surgery, a visual grid system was used to define the anatomical landmarks which were located 20 mm apart. When the unipolar technique was used to assess the anomalous pathway location, there was a difference corresponding to a distance of 2-2.5 anatomical landmarks (48 mm) between the preoperative and intra-operative assessments. With the bipolar technique the difference was up to 3 anatomical landmarks (60 mm) while it was up to 4.5 anatomical landmarks (90 mm) when the withdrawal technique was employed. The unipolar technique was superior in differentiating a left lateral from a left posterior or a septal location.

The automatic implantable cardioverter-defibrillator: efficacy, complications, and device failures.

Twenty-six patients with refractory ventricular arrhythmias received the automatic implantable cardioverter-defibrillator. A patch lead only was placed during arrhythmia surgery in 7 other patients. During 13 +/- 6 (SD) months, the device discharged in 10 patients because of a sustained ventricular arrhythmia. No sudden deaths occurred. There were 31 complications in 17 patients, including postoperative refractory heart failure, coronary artery erosion, subclavian vein thrombosis, postoperative stroke after conversion of atrial fibrillation, atelectasis with pneumonia, symptomatic pleural effusions, and infection at the generator site. The cardioverter-defibrillator discharged in 9 asymptomatic patients, failed to terminate ventricular fibrillation during postoperative testing in 3 patients, and had premature battery failure in 4 patients. Tachycardia slowing during chronic amiodarone therapy and unipolar ventricular pacing during ventricular fibrillation precluded or delayed arrhythmia sensing. Thus, the cardioverter-defibrillator can be life saving, but its potential complications and interactions with antiarrhythmic drugs and pacemakers must be considered at patient selection.

Appropriate diagnostic studies for arrhythmia surgery.

Appropriate diagnostic studies for arrhythmia surgery.

The Wolff-Parkinson-White Syndrome and the Beginnings of Direct Arrhythmia Surgery

The bundle of Kent, one of the two pathways involved in the reentry tachycardia of the Wolff-Parkinson-White syndrome, was identified and then interrupted fifteen years ago. This marked the beginning of direct arrhythmia surgery. The patient was a 31-year-old man with a right free wall pathway and persistent tachycardia refractory to medical treatment. In the present report, the historical landmarks in the description of the morphology of the conduction system are reviewed. Current methods of interrupting the Kent bundle, based on experience with more than 200 surgical patients, are discussed. Included is the newer method of simplifying the surgical procedure with cryothermia. Speculation about the future of direct arrhythmia surgery is given in the concluding remarks.

Incessant ectopic atrial tachycardia: successful surgical treatment with regression of dilated cardiomyopathy picture

Ectopic atrial tachycardia is an unusual arrhythmia that usually occurs at a young age. t-3 It may be paroxysmal 2,~ or incessant, l-u The atrial rate is often more than 200 beats/min, especially in children. Other typical findings are abnormal frontal P-wave morphologic characteristics 4 and resistance to conventional antiarrhythmic therapy. 3 The incessant form of ectopic atrial tachycardia is sometimes associated with signs and symptoms of cardiac failure,/, 3,4 mimicking dilated cardiomyopathy. In such cases, it has not been possible to determine whether the arrhythmia is the primary cardiac disorder or a consequence of a myocardial disease.ran When an area responsible for the initiation or maintenance of an arrhythmia can be accurately defined, one prerequisite for elective arrhythmia surgery is fulfilled. Although the origin of ectopic atrial tachycardia can be localized in that way, few reports have described successful cases of surgical elimination of ectopic atrial tachycardia. 4-6 We observed 2 young patients with incessant ectopic atrial tachycardia in whom surgical treatment eliminated both the arrhythmia and the dilated cardiomyopathy.

Cardiac Arrhythmias: A Decade of Progress

In May 1980, current knowledge of cardiac arrhythmias and antiarrhythmic therapy was presented in a medical symposium held at Stanford University under the direction of Dr Donald C. Harrison and sponsored by the Astra Pharmaceutical Co. Forty-eight different presentations from that symposium, reflecting important advances in the understanding of cardiac arrhythmias and antiarrhythmic therapy since 1970, have been compiled by Harrison in<i>Cardiac Arrhythmias: A Decade of Progress</i>. The text contains 16 sections reviewing the genesis of cardiac arrhythmias, the theoretical basis of antiarrhythmic drug action, the use of new antiarrhythmic drugs, drug interactions, electrophysiological studies, electrical therapy, and surgery for cardiac arrhythmias. The efficacy of antiarrhythmic drugs in acute myocardial infarction and the surgical approaches to the prevention and treatment of cardiac arrhythmias are especially well discussed. Seven chapters are devoted to tocainide therapy for cardiac arrhythmias, reflecting the special interest of Astra Pharmaceutical Co. Controversies regarding electrophysiological mapping

Coronary artery surgery for recurrent ventricular arrhythmias in patients with variant angina

Two patients with Prinzmetal's variant angina had recurrent episodes of resting chest pain, ST segment elevation, QRS widening, ventricular tachycardia, and ventricular fibrillation. These episodes were unresponsive to medical therapy including lidocaine, procaine amide, and quinidine sulfate. Coronary arteriography revealed severe obstructive coronary artery disease, involving more than one coronary artery, in both patients. Aorticocoronary saphenous vein grafts were utilized to bypass significant disease in each patient. In one patient blood flow through the grafts was measured at 90 and 65 ml per minute, respectively, at operation and patent grafts were demonstrated six months postoperatively. Neither patient has had recurrence of chest pain or evidence of ventricular tachycardia at one year or 2 1 2 years postoperatively. Postoperative resting and maximal exercise ECG's are normal. Coronary artery surgery may be an effective method of therapy for ischemic ventricular tachycardia when medical therapy fails.

ARRHYTHMIA AND ORAL SURGERY: INDUCTION OF ANAESTHESIA WITH ALTHESIN

Induction of anaesthesia with Althesin appears to offer a significant protective effect against the cardiac arrhythmias which may follow the stimulus of oral surgery.

THE PROGNOSIS OF THE WOLFF-PARKINSON-WHITE SYNDROME

Excerpt Many authors, including Wolff, Parkinson and White,1consider the prognosis of the Wolff-Parkinson-White syndrome (characterized by White et al.1essentially as: (1) a short P-R interval, (2)...