Search

Most of pts with severe ventricular dysfunction and left bundle branch block who undergo to biventricular pacing (CRT) have diastolic dysfunction (DD), due to ventricular stiffness. Aim of our study: to evaluate the effects of CRT on DD.Methods 21 pts (16 m; 72 ± 7,5 yrs) with EF ≤ 0.35, NYHA class ≥ 3, echocardiographic criteria of desynchronization and DD, underwent to biventricular pacing. Clinical, ECG and echocardiographic data (E/A ratio, deceleration time, isovolumetric relaxation time and S/D ratio on the pulmonary veins flow, to classify DD as mild, moderate or severe) were collected at baseline and at a mean follow-up (FU) of 188 ± 119 days. We divided pts into 2 groups, according to the improvement (A) or not (B) of the DD. Results 11 pts (52%) improved. In both groups, CRT induced significative decrease of NYHA class (A 3.4±0.6 vs 2.1±0.6; p<.001; B 3.6±0.6 vs 2±0.7; p<.001), improvement of the qol (decrease of Minnesota, A 50±16 vs 30±10; p=.002; B 58±19 vs 27±15; p<.001), of the EF (A 0.28±0.09 vs 0.38±0.09; p=.02; B 0.25±0.07 vs 0.32±0.07; p=.04) and of interventricular asynchrony (A 65±32 vs 4.5±38, p<.001; B 54±14 vs 2.8±44, p=.0025). Group A also showed a significative reduction of QRS (194±29 ms vs 138±18 ms; p<.0001) and improvement of intraventricular asynchrony (lateral wall delay 500±60 vs 420±29, p=.003). Conclusions The improvement of DD seems to be correlated to a greater decrease of the QRS interval and to a greater reduction of the lateral wall delay, meaning a greater intraventricular resynchronization effect. [ABSTRACT FROM PUBLISHER]

Patients with permanent right ventricular apical pacing may develop interventricular and intraventricular dyssynchrony as a consequence of the pacing-induced “LBBB-like” ventricular activation. Aim of the study: to compare the effects of cardiac resynchronization therapy (CRT) in pts with spontaneous LBBB and with PILBBB.Methods 68 pts with severe HF (EF < 0.35; NYHA class ≥ 3) (73±7 yrs; 63 m) underwent to biventricular pacing. Pts were divided in 2 groups: LBBB (49 pts; 71±8 yrs; 39 m) and PILBBB (29 pts; 75±6 yrs; 24 m). Clinical, echocardiographic and ECG data were collected at baseline and post implant: mean follow-up (fu): 11±7 months. Results In both groups, CRT induced significative decrease of NYHA class (LBBB: 3.4±0.5 vs 2.1±0.8 in the fu; p<0.01) (PILBBB: 3.4±0.5 vs 2.1±0.7 at fu; p<0.01), an improvement of the quality of life (QOL), as confirmed by the decrease of the Minnesota QOL questionnaire (LBBB: 60±24 vs 45±28 at fu; p<0) (PILBBB: 71±25 vs 43±21 at fu; p=0.03), an increasing of the EF (LBBB 0.27±0.06 vs 0.34±0.09 at fu; p<0.01) (PILBBB 0.24±0.07 vs 0.34±0.09 at fu; p<0.01) and a significative reduction of the QRS duration (LBBB 178±27 ms vs 149±25 ms at fu; p<0.01)(PILBB193±27 ms vs 144±23 ms at fu; p<0.01). All the differences, both at baseline and during the follow-up, were not statistically significant. Conclusions Patients with advanced HF and mechanical dissyncrony secondary to PILBBB show similar improvement in symptoms and cardiac performance compared to pts with LBBB, so they can be considered as good candidates to upgrading to biventricular pacing. [ABSTRACT FROM PUBLISHER]

Vigorous physical exertion may be correlated to a greater incidence of atrial fibrillation (AF). Aim of the study: to evaluate the incidence of AF in agonistic athletes with palpitations of unknown origin.Methods We evaluated 37 athletes (27 m, 28 ± 12 yrs) with palpitations of unknown origin. We performed ECG to exclude ventricular pre-excitation, echocardiography to exclude structural heart disease and transesophageal electrophysiological study (TEES) to evaluate the induction of arrhythmias. Results 16 pts (43%) were agonistic athletes (A, 13 m, 23 ± 10 yrs), 21 practiced regular physical activities (B, 14 m, 32 ± 12 yrs). In group A, TEES was negative in 50%, AF was induced in 4 pts (25%), atrio-ventricular nodal reentrant tachycardia (AVNRT), unsustained ventricular tachycardia of the right ventricle outflow tract, common atrial flutter (afl) and focal atrial tachycardia (FAT) in 1 pt (6.25%). In group B, TEES was negative in 13 pts (62%), AF was induced in 2 pts (9.5%), AVNRT in 4 (19%) and afl in 2 (9.5%). Among the athletes in which AF was induced (4 pts), 1 stopped agonistic activity. Conclusions 1) In athletes with palpitations of unknown origin, sustained AF is inducible in 37% of cases during TEES; 2) the inducibility for AF is higher (although not significantly, p=0.2) in agonistic athletes (25%) than in patients practising non agonistic physical activity (9.5%); 3) TEES is useful in the evaluation of athletes with palpitations of unknown origin. [ABSTRACT FROM PUBLISHER]

Brugada syndrome (BS) can be a familiar disease.Aim of the Study To evaluate clinical and electrocardiographyc characteristics of parents of pts affected by BS. Methods We evaluated 6 families affected by BS (A). A group of healthy pts was evaluated as control group (B). Familiar BS was diagnosed if a pt with type 1 ECG pattern and cardiac arrest or sudden death or syncope with positive electrophysiological study and a pt with type 1 ECG pattern were present in the same family. Conclusions 1) Among parents of pts affected by familiar BS, 33% shows a type 1 ECG pattern. 2) In this population, we observed a high percentage of events (sudden death or cardiac arrest in 35%). 3) Parents of pts affected, without a type 1 ECG pattern, frequently show ECG signs of right ventricular delay (S wave in DI or DII or V6), of unknown origin. [ABSTRACT FROM PUBLISHER]

Left atrial stretch and dilatation can favour the development of atrial ectopies and atrial fibrillation (AF). Only few and conflicting data are available about the relationships between the size of the pulmonary veins (PVs) and their arrhythmogenicity.Aim to investigate on correlations between the size of the PVs and their arrhythmogenicity. Methods Eight patients (mean age 57±13 years; 6 males) with recurrent paroxismal AF were studied. In every patient only one vein was arrhythmogenic. It was possible to identify the arrhythmogenic pulmonary vein (APV) with the firing focus by means of the analysis of multiple ECG recordings, Holter recordings, and the data of the electrophysiological test. Every patient underwent a cardiac spiral CT and the diameters of the PVs were measured at the ostia. Results the APV was: left superior in 62.5%; right superior in 37.5%. In 75% of patients the APV was the vein with the largest diameter. The diameters of the APVs resulted to be significantly larger when compared to the non-APVs (20.4±5,7 mm vs 17.0±3,0 mm; p<0.05). Four patients (50%) showed an additional PV (2 top right and 2 middle right). Conclusions Our study, performed in a small number of patients with focal AF, seems to confirm a correlation between the diameter of the pulmonary veins and their arrhythmogenicity. [ABSTRACT FROM PUBLISHER]