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Palpitations can be defined as an unpleasant feeling of heart beat, which is perceived as particularly fast, irregular or intense. This feeling is usually associated with perception of movements and hits in the chest. From the pathophysiological point of view, current knowledge of the neural pathways responsible for the perception of heart beat remains to be clearly elucidated. It has been hypothesized that these pathways include different structures located both at the intracardiac and extracardiac level. Palpitations are a widely diffused complaint in the general population, and particularly in subjects affected by structural heart disease. Clinical presentation makes it possible to divide palpitations into four groups: extrasystolic, tachycardic, anxiety-related, and intense. From the etiological point of view, palpitations may be divided into the following groups: palpitations caused by arrhythmias, by structural heart disease (non-arrhythmic), by psychiatric disease, by systemic noncardiac disease, and by drug or illicit substance assumption. The prompt detection of the causes of palpitations allows to identify clinical conditions potentially at high risk and to choose the most appropriate therapeutic approach.

The recent withdrawal from the market of nadolol (Corgard; Bristol-Myers Squibb, Sermoneta, Italy) and quinidine polygalacturonate (Ritmocor; Malesci, Bagno A Ripoli, Italy) has been causing clinical problems to many cardiologists and patients, frequently leading to discontinuance of an effective and well-tolerated pharmacological treatment. Nadolol is useful in the treatment of severe and refractory arrhythmias, particularly in some genetically determined ion-channel diseases, such as long-QT syndrome and catecholaminergic polymorphic ventricular tachycardia.Quinidine is still used in refractory atrial fibrillation recurrences. Recent studies have demonstrated the clinical efficacy of quinidine in the treatment of rare genetically determined ion-channel diseases at high risk of sudden death, such as Brugada syndrome and short-QT syndrome.We hope that scientific societies can influence healthcare and pharmaceutical institutions, in order to restore the availability of two cardiovascular drugs that are extremely important in the care of arrhythmic patients.

Introduction: Radiofrequency (RF) catheter ablation has not been widely undertaken in elderly patients. The aim of our study was to compare the success rate of radiofrequency ablation and the incidence of severe procedural complications in young-adult and elderly patients., Methods: We enrolled all patients undergoing radiofrequency catheter ablation procedures for supraventricular and ventricular arrhythmias at our Cardiology Department from January 2000 to December 2005. The patients were divided into two groups according to age: patients aged <70 years (group A) and those aged >or=70 years (group B). Group B was then divided into two subgroups: B1 (age 70-79 years) and B2 (age >or=80 years). We recorded the incidence of procedural complications and the long-term efficacy (mean follow-up 46 +/- 20 months)., Results: We studied 605 patients, 69% in group A and 31% in group B (24% in subgroup B1 and 7% in B2). The prevalence of structural heart disease was higher in elderly patients than in young adults (83 vs 37%, p < 0.01). The rate of procedural complications was 1.3%; no differences emerged between groups A and B (1.2 vs 1.5%, p = NS) or among groups A, B1 and B2 (1.2 vs 1.4 vs 2%, p = NS). The success rate of catheter ablation was 91%, with no differences between the age-groups (92 vs 88%, p = NS) or among groups A, B1 and B2 (92 vs 88 vs 88%, p = NS)., Conclusion: Catheter ablation in elderly and very elderly patients is as effective and safe as in young-adult subjects, at least in cases which do not require left heart catheterization.