AV Junctional Tachycardia Research Articles

Long‐Term Survival After Closed‐Chest His‐Bundle Ablation with DC Shock for Supraventricular Arrhythmias: A 10‐Year Experience with 317 Consecutive Patients

Survival after closed-chest ablation of His bundle with DC shock for supraventricular arrhythmias was analyzed for a 10-year period (May 1982-December 1992) with 317 consecutive patients (167 males, 150 females; mean age 66 years; range 33-93 years). Of these, 54 patients died (17.3%) and 5 were lost to follow-up. The mean age at ablation was 70.3 +/- 8.3 years with a range of 49-93 years. Of those who died, the mean survival was 30.5 +/- 28.6 months with a range of 36 hours to 120 months; the diagnosis of heart disease was: hypertension (n = 14), cardiomyopathy (n = 8), ischemic (n = 7), valvular (n = 6), cor pulmonale (n = 3), valvular and ischemic (n = 2), hypertension and ischemic (n = 1), miscellaneous (n = 3), and none (n = 10). Of the patients who died after ablation, the arrhythmias at the time of the ablation were atrial fibrillation (AF; n = 33), sick sinus syndrome (n = 5), atrial flutter (AFL; n = 4), paroxysmal AV junctional tachycardia (PAVJT; n = 4), AF + AFL (n = 4), atrial tachycardia (n = 2), PAVJT + AFL (n = 1), and AF +AFL + atrial tachycardia (n = 1). Death was sudden in 13 patients (25%), due to heart failure in 10 (19.2%), myocardial infarction in 4 (7.7%), stroke in 4 (7.7%), aortic vascular accident in 3 (5.8%), miscellaneous in 18 (34.6%), and undetermined in 2.(ABSTRACT TRUNCATED AT 250 WORDS)

Flutter and fibrillation-like phenomenon of his bundle observed in a patient with persistent atrial standstill

A diagnosis of persistent atrial standstill was made in a patient with syncopal attacks, based on: (1) the lack of P waves both in the routine 12-lead electrocardiogram (ECG) and in the right atrial cavity lead; (2) the absence of "a waves in the right atrial pressure curve; and (3) the failure of the atria to respond to electrical stimulation. Compared with previously reported cases of persistent atrial standstill with a slow, regular escape rhythm of supraventricular origin, the present case was characterized by alternate periods of bradycardia and tachycardia, the latter being suggested as AV junctional tachycardia with exit block. Furthermore, the His bundle electrogram (HBE) showed either regular, high frequency deflictions or irregular, deformed potentials, suggesting flutter and fibrillation-like phenomena in the His bundle.

Treatment of Acute Arrhythmias with Orally Administered Tolamolol

Orally administered tolamolol, a new cardioselective beta-adrenergic blocking drug, was evaluated in 30 patients with supraventricular arrhythmias or digitalis-induced arrhythmias. Tolamolol therapy slowed the rapid ventricular rate in ten of ten patients with atrial fibrillation and converted two of these ten patients to sinus rhythm. It slowed the rapid ventricular rate in eight of eight patients with atrial flutter and converted two of these eight cases to sinus rhythm. It converted to sinus rhythm four of four patients with paroxysmal atrial tachycardia or paroxysmal atrioventricular AV junctional tachycardia. It abolished supraventricular premature ventricular beats in three of three patients. It abolished digitalis-induced paroxysmal atrial tachycardia with AV block in three of three patients, digitalis-induced premature ventricular contractions in three of three patients, and digitalis-induced AV junctional tachycardia in one patient. Oral administration was effective in treating supraventricular arrhythmias and certain digitalis-induced arrhythmias.