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One hundred and sixty consecutive patients less than 50 years of age (mean 38 years) referred for long term electrocardiographic recording were evaluated retrospectively. Significant cardiac arrhythmias were detected in 51 of 107 (48%) patients examined because of syncope or dizzy spells or both. Of 39 patients examined for cardiac complaints or presumed complex arrhythmias, 15 (38%) had significant arrhythmias. Of 14 patients examined because of otherwise unexplained strokes, nine had slow sinus rates. Of these, one patient had recently undertaken moderately intensive athletic activity and four had been undertaking vigorous athletic activities for several years. All of the 12 active athletes who were followed up on account of syncope or dizzy spells were free of symptoms after reducing their athletic activities. The cardiac rhythm returned to normal in four out of five who underwent repeat long term electrocardiographic recording. It is suggested that vigorous athletic activity in subjects of 30-50 years of age may transform the adaptative bradycardia of the athlete into a condition similar to the embolising sick sinus syndrome. [ABSTRACT FROM PUBLISHER]

Using strictly defined criteria of significant arrhythmias, long term electrocardiographic recording has been evaluated for confirmation of arrhythmias as the cause of cerebral symptoms in 81 patients with suspected Adams-Stokes syndrome. Extension of long term electrocardiographic recording for more than 24 hours gives marginal additional information at a high cost. Among 43 patients monitored until symptoms appeared, non cardiogenic causes were confirmed in 20 of 22 patients because the recording showed normal rhythm during symptoms. Fifteen of 21 patients with a significant arrhythmia during an asymptomatic 24 hour recording later had the same arrhythmia during symptoms. Of 38 patients who failed to develop symptoms, 21 had a significant arrhythmia detectable within 24 hours and 23 when 48 hours of recording were analysed. [ABSTRACT FROM PUBLISHER]

Background: There is a knowledge gap regarding aetiology of and potential for predicting out-of-hospital cardiac arrest (OHCA) among individuals who are healthy before the event.Aim: To describe causes of OHCA and the potential for predicting OHCA in apparently healthy patients.Methods: Patients were recruited from the Swedish Register of Cardiopulmonary Resuscitation from November 2007 to January 2011. Inclusion criteria were: OHCA with attempted CPR but neither dispensed prescription medication nor hospital care two years before the event The register includes the majority of patients suffering OHCA in Sweden where cardiopulmonary resuscitation (CPR) was attempted. Medication status was defined by linkage to the Swedish Prescribed Drug Register. Cause of death was assessed based on autopsy and the Swedish Cause of Death Register. Prediction of OHCA was attempted based on available electrocardiograms (ECG) before the OHCA event.Results: Altogether 781 individuals (16% women) fulfilled the inclusion criteria. Survival to 30 days was 16%. Autopsy rate was 72%. Based on autopsy, 70% had a cardiovascular aetiology and 59% a cardiac aetiology. An ECG recording before the event was found in 23% of cases. The ECG was abnormal in 22% of them.Conclusion: Among OHCA victims who appeared to be healthy prior to the event, the cause was cardiovascular in the great majority according to autopsy findings. A minority had a preceding abnormal ECG that could have been helpful in avoiding the event. [ABSTRACT FROM AUTHOR]

The prevalence of serious episodic cardiac arrhythmias known to correlate with cerebral symptoms was investigated in 103 elderly, randomly selected persons with the aid of 22 hours of long-term ECG recording (LTER). Twelve of 26 subjects with dizziness/syncope had serious episodic arrhythmias compared with 5 of 77 subjects without these symptoms. This difference is significant (p less than 0.001). Five patients fulfilled strict criteria for pacemaker treatment of symptomatic bradycardias. Three had the sick sinus syndrome and two had third degree atrioventricular block. In 4 subjects, drugs were withdrawn due to bradycardia; and 4 were treated for tachyarrhythmias. Despite the finding of minor arrhythmnias in almost all asymptomatic subjects, it is concluded that serious episodic arrhythmias in the elderly are related to cerebral symptoms. It is also concluded that these arrhythmias are more common than previously believed and that LTER should be widely used.

The rate of accidents severe enough to require a roentgen examination was investigated in a series of patients with episodic cardiac arrhythmia of types causing Adams-Stokes' syndrome. The accident rate was doubled compared with controls without known Adams-Stokes' syndrome but the associated increase in fracture rate was not significant.

Fifty-eight consecutive patients admitted to hospital for fracture of the upper end of the femur were examined by continuous ECG monitoring for 22--24 hours. More than one third of the patients had occult, previously unknown episodic arrhythmias severe enough to cause dizzy spells and syncope. These patients had more often a history of dizziness and syncope and could less frequently than patients without serious arrhythmias return to their homes at the time of discharge despite uncomplicated fracture treatment.

The aim of the present study was to compare the prediction of bradyarrhythmias via the corrected sinus node recovery time and the His bundle electrogram with the findings made during long term electrocardiographic recording. Ninety-two patients, aged 17-88 years, were included in the study with a suspicion of Adams-Stokes' syndrome. During long term electrocardiographic recording only 40 patients had symptoms while 52 could not tolerate long term electrocardiographic recording until symptoms had appeared. Seven out 37 patients with sick sinus syndrome and 2 out of 9 with atrioventricular block 2 degrees/3 degrees had additional significant ventricular arrhythmias. A total of 10 patients had prolonged (greater than or equal to 160 msec) atrium to His intervals, among them 2 had significant ventricular arrhythmia but failed to have symptoms during long term electrocardiographic recording. In 22 patients the His to ventricle interval was moderately prolonged (56-79 msec), among them 7 had significant ventricular arrhythmias (5 with symptoms during long term electrocardiographic recording). Out of 5 patients with markedly H-V interval prolonged, 3 patients had 2 degrees/3 degrees atrio-ventricular block and 1 patient had atrial tachyarrhythmia during long term electrocardiographic recording. In conclusion prolonged H-V intervals are frequent in patients with episodic atrioventricular block but also in patients who have symptomatic ventricular tachyarrhythmias. Long term electrocardiographic recording is essential for the differentiation between symptomatic ventricular arrhythmia and symptomatic atrioventricular block in patients with prolonged HV-intervals.

In a retrospective study, the frequency of atrial arrhythmias of types known to cause systemic embolisation and the effect of anticoagulant treatment were studied in 106 patients with arterial embolism. Such embolising arrhythimas were found in 84 patients (79%). Permanent atrial fibrillation was documented in 53 patients (50%) and episodic atrial arrhythmia was encountered in 28 patients (26%). In 21 of 28 patients with sinus rhythm on admission, an embolising arrhythmia could be identified in previous ECG recordings. Patients with atrial arrhythmias had a significantly higher rate of prior embolic episodes and embolic events during follow-up (53 events in 84 patients) compared to the patients without arrhythmia (6 events in 22 patients) (P less than 0.05). In patients with atrial arrhythmias postoperative treatment with peroral anticoagulation was associated with a lower mortality (P less than 0.003) and a lower rate of reembolisation and stroke (P less than 0.0005). It is concluded that every fourth patient presenting with arterial embolism had an atrial arrhythmia of episodic nature. Most of these patients had normal sinus rhythm on admission but could be identified in previous ECG recordings. This study suggests that patients with arterial embolism and atrial arrhythmia have a higher risk of further embolisation with an ensuing risk of morbidity and death, compared to patients without arrhythmia. A positive effect of anticoagulation seemed to be present in patients with atrial arrhythmia whereas such a positive effect could not be identified in patients without arrhythmia.

This paper gives data on symptomatic patients with bradycardia found not at random but as the result of greatly expanded facilities for recognition of arrhythmias. The incidence of patients with symptomatic bradycardia was very high. Most patients had intermittent arrhythmias and diagnosis was often only possible after long-term ECG screening. Symptoms were as severe, and relief of symptoms with treatment was as good, as in pacemaker-treated patients described by others. Our conclusion is that indications for arrhythmia screening should be increased, as the diagnosis and treatment are very worthwhile. We refer to the systematized active diagnosis and treatment of arrhythmias in patients with cerebral symptoms as cardiogenic neurology.