Cardiac Arrhythmias 1997

556 Pages·1998·13.151 MB·English

by  M. A. Allessie, F. J. Chorro, M. C. E. F. Wijffels, F. Mast, R. Dorland (auth.), Antonio Raviele MD (eds.)

Cardiac Arrhythmias 1997
Springer-Verlag Italia Srl.
Cardiac Arrhythmias 1997
Edited by
Antonio Raviele
Proceedings of the
5th International Workshop
on Cardiac Arrhythmias
(Venice, 7-10 October 1997)
Springer
ANTONIO RAVIELE, MD
Divisione di Cardiologia
Ospedale Umberto I
Via Circonvallazione 50
l-30174 Venezia Mestre
ISBN 978-88-470-2290-4
Library of Congress Cataloging-in-Publication Data International Workshop on Cardiac
Arrhythmias (5th: 1997: Venice, Italy) Cardiac arrhythmias 1997: proceedings of the 5th
International Workshop on Cardiac Arrhythmias, Venice, 7-10 October, 1997 I edited by
Antonio Raviele. --1st ed. p. em. Includes bibliographical references and index.
ISBN 978-88-470-2290-4 ISBN 978-88-470-2288-1 (eBook)
DOI 10.1007/978-88-470-2288-1
1. Arrhythmias--Congresses. I. Raviele, Antonio. II. Title. [DNLM:
1. Arrhythmias--congresses. WG 330 I625c 1997] RC685.A651575 1997 616. 1'28--dc21
DNLM/DLC for Library of Congress 97-36011 CIP
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Preface
This book contains the Proceedings of the "sth International Workshop on
Cardiac Arrhythmias" held in Venice on October 7-10, 1997. They represent an
update on the most recent advances in the diagnosis, prognosis and treatment of
cardiac arrhythmias; the contributions, made by numerous well-known world
leaders in the field of clinical electrophysiology and arrhythmology, cover an
array of timely topics including fibrillation and other supraventricular tach
yarrhythmias, diagnosis and management of ventricular arrhythmias; risk strati
fication and prevention of sudden death in post-myocardial infarction patients:
technological advances, clinical issues and new indications of lCD therapy,
update on syncope and progress in clinical pacing.
I would like to express my sincere and profound gratitude to all the Authors that
with enthusiasm and devotion have allowed the realization of this book. Without
their effort and excellent job this volume would not have been possible.
A special word of thanks also to the Publisher, Springer-Verlag, that with great
expertise and care has followed the production process of the book.
Finally, my deepest appreciation goes to Prof. Eligio Piccolo for his example and
continuous encouragement, to my present colleagues, in particular Dr. De Piccoli,
Di Pede, Rigo, Bonso, Zuin and Gasparini, for their unvaluable help in preparing
and realizing the workshop and to my wife and children for their patience, per
sonal sacrifice and support.
Antonio Raviele
The Authors wish to thank Synthelabo for the support
in the realization oft his volume
Table of Contents
ATRIAL FIBRILLATION: MECHANISM AND CLINICAL ASPECTS . . . . . . . . 1
What Are the Electrophysiological Mechanisms of Perpetuation of
Atrial Fibrillation?
M.A. Allessie, F.J. Chorro, M.C.E.F. Wijffels, F. Mast and R. Dorland 3
Vagal Tone: How Important Is It in Triggering Atrial Fibrillation?
A. Capucci, G.Q. Villani, D. Aschieri and A. Rosi . . . . . . . . . . . . . . . . . . . . . . . . 12
Tachycardia Induced Atrial Fibrillation: What Incidence? How to diagnose
and Treat It?
P. Delise, L. Coro, P. Scipione and M. Fantinel . . . . . . . . . . . . . . . . . . . . . . . . . . 18
ATRIAL FIBRILLATION: CARDIOVERSION AND DRUG PROPHYLAXIS 25
Restoration of Sinus Rhythm: Pharmacological or Electrical?
M. Chimienti, S. Barbieri and G. Guazzotti . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
Atrial Fibrillation: Which Drug to Prefer for Acute Cardioversion?
N. Baldi, V.A. Russo, V. Morrone, G. Marasco and G. Polimeni . . . . . . . . . . . . 33
Drug Prevention of Paroxysmal Atrial Fibrillation, When and How?
H.J.G.M. Crijns and I. C. Van Gelder . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40
Antiarrhythmic Drug Administration before Electrical Cardioversion of
Atrial Fibrillation: Is It Useful to Prevent Early Arrhythmia Recurrence?
G. Boriani, M. Biffi, G. Bronzetti, L. Frabetti, A. Capucci, A. Branzi and
B. Magnani . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45
ATRIAL FIBRILLATION: ABLATION PROCEDURES . . . . . . . . . . . . . . . . . . . . 51
AV-Nodal Ablation versus AV-Nodal Modification for Control of
Atrial Fibrillation
A.P. Fitzpatrick . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53
VIII Table of Contents
AV Junction Modification for Atrial Fibrillation: Which End Points?
A. Bonso, S. Themistoclakis, G. Gasparini and A. Raviele . . . . . . . . . . . . . . . . 58
Heart Failure Patients with Atrial Fibrillation: How Important Is It to
Regularize Ventricular Rhythm?
P.E. Vardas, E.N. Simantirakis and E.G. Manios . . . . . . . . . . . . . . . . . . . . . . . . 66
Catheter Ablation of Atrial Fibrillation: Where Are We Now and
Where Are We Going?
M. Haissaguerre, P. Jais, D.C. Shah, M. Hocini, W. Bruszewski, A. Takahashi,
S.S. Barold and J. Clementy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72
ATRIAL FIBRILLATION: INTERNAL DEFIBRILLATION . . . . . . . . . . . . . . . . . 81
Restricted or Expanded Indications for Low-Energy Internal Cardioversion?
M. Santini, C. Pandozi, G. Gentilucci and M. Villani . . . . . . . . . . . . . . . . . . . . 83
Internal Atrial Defibrillation: What Are the Effects on Mechanical Function?
F. Rigo,A. Raviele,B. De Piccoli, G. Gasparini,M. Ragazzo and
C. Zanella . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89
Implantable Atrial Defibrillator: Which Results and Indications?
W. Jung and B. Liideritz . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100
The Implantable Atrial Defibrillator: Are All the Problems Solved?
S. Uvy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 110
ATRIAL FIBRILLATION: PREVENTION OF THROMBOEMBOLISM . . . . . . . 113
Atrial Fibrillation and Thromboembolic Risk: Is It Safe to Cardiovert
Acutely under Heparin?
M. Disertori and A. Menotti . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . 115
Prevention of Thromboembolism in Atrial Fibrillation: When Antiplatelet
Agents and When Anticoagulants?
G. Di Pasquale, G. Pinelli, S. Urbinati, S. Biancoli, L.G. Pancaldi, A. Pozzati,
S. Vinelli, B. Sassone and F. Ottani . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 125
ATRIAL FLUTTER AND OTHER SUPRAVENTRICULAR
TACHYARRHYTHMIAS. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 135
Inappropriate Sinus Tachycardia: Mechanism and Therapy
C. Pappone, G. Oreto, M. Rillo and S. Chierchia . . . . . . . . . . . . . . . . . . . . . . . . 137
TableofContents IX
What Is the Relationship between Atrial Fibrillation and Flutter in Man?
M.D. Lesh, F.X. Roithinger, M.R. Karch, P.R. Steiner and
A. SippensGroenewegen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 144
Physiology of AV Junction: What Have We Learnt from
Radiofrequency Ablation?
F. Gaita, R. Riccardi, M. Scaglione, L. Calo, E. Richiardi, L. Garberoglio and
P. DiDonna . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 152
What Is the Clinical Significance of Ventricular Repolarization Abnormalities
during Supraventricular Tachyarrhythmias?
N. Paparella, G. Fuca, Y. Panayou and P. Alboni . . . . . . . . . . . . . . . . . . . . . . . . 158
Prolonged or Failed Attempts at RF Ablation of Accessory Pathways:
What Are the Causes?
J.A. Salerno-Uriarte, R. De Ponti, C. Storti, M. Zardini and
M. Longobardi . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 166
SUDDEN DEATH RISK STRATIFICATION AFTER ACUTE MYOCARDIAL
INFARCTION. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 173
What Is the Clinical and Prognostic Significance of Atrioventricular and
Intraventricular Conduction Defec;ts?
E. Piccolo and G. Zuin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 175
What Is the Usefulness of Ventricular Premature Beats and Ventricular Late
Potentials in the Thrombolytic Era?
M. Di Biase, D. De Laura, M. V. Pitzalis and P. Rizzon . . . . . . . . . . . . . . . . . . . . 183
What Is the Predictive Value of Heart Rate Variability and Baroreflex
Sensitivity?
R.F.E. Pedretti . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 188
Clinical Usefulness of QT Prolongation, QT Dispersion and T-Wave
Alternans
X. Vifiolas, A. Cabrera and A. Bayes de Luna . . . . . . . . . . . . . . . . . . . . . . . . . . . 198
Risk Stratification after Acute Myocardial Infarction: What Is the
Usefulness of Programmed Ventricular Stimulation ?
M. Zoni-Berisso and D. Silvestri . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 213