Cardiac Arrhythmias 2001: Proceedings of the 7th International Workshop on Cardiac Arrhythmias (Venice, 7–10 October 2001)

668 Pages·2002·14.05 MB·English

by  P. M. Spooner (auth.)

Cardiac Arrhythmias 2001
Springer-Verlag Italia Srl.
Cardiac Arrhythmias 2001
Edited by
Antonio Raviele
Proceedings ofthe
7th International Workshop
on Cardiac Arrhythmias
(Venice, 7-10 October 2001)
~Springer
ANTONIO RAVIELE, MD
Divisione di Cardiologia
Ospedale Umberto I
Via Circonvallazione 50
I-30174 Venezia Mestre
The Editor and Authors wish to thank KNOLL FARMACEUTICI S.p.A. for the
support and help in the realization of this volume
© Springer-Verlag Italia 2002
Originally published by Springer-Verlag Italia, Milan in 2002.
Softcover reprint of the hardcover 1st edition 2002
ISBN 978-88-470-2165-5 ISBN 978-88-470-2103-7 (eBook)
DOI 10.1007/978-88-470-2103-7
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Preface
The field of cardiac arrhythmias has been evolving so fast during the last years
that scientific meetings are frequently necessary to present technological
advances, to communicate results of relevant and innovative researches, to
assess the impact of recently developed diagnostic and therapeutical tools, to
discuss controversial aspects, and to reach a consensus on the most appropriate
evaluation and management of specific problems. This is the main reason why
in 1988 we started to organize a biannual International Workshop on Cardiac
Arrhythmias. Since then many editions of the workshop have taken place and
over the years the fame and popularity of the event have increased continuously.
This book contains the Proceedings of the Seventh Edition of the Workshop
held in Venice at the Fondazione Giorgio Cini from the 7th to the lOth of
October 2001. During the meeting all the principal aspects of the different
arrhythmias, from epidemiology to physiopathology, electrogenetic mecha
nisms, diagnosis, prognosis, treatment, pshycological implications and econom
ic costs have been discussed among the numerous experts and participants.
The book is divided in seven sections, each dedicated to a different topic:
evaluation and management of syncope; rationale, indications and results of
cardiac resynchronization therapy; risk stratification and prevention of ven
tricular arrhythmias and sudden death; diagnosis and therapy of atrial flutter
and other supraventricular tachyarrhythmias; electrogenetic, clinical and ther
apeutical aspects of atrial fibrillation; non-pharmacological therapy of atrial
fibrillation; technological and practical issues of pacemaker therapy. In my
opinion, the book represents a comprehensive and modern overview of all per
tinent aspects of cardiac arrhythmias and should be of interest not only to elec
trophysiologists and experts of the sector but also to general cardiologists,
internists and medical students. I hope it will contribute to a better diffusion of
current knowledge on cardiac arrhythmias and motivate researches in this
field.
Many recognized authors have contributed to this volume. I am deeply
indebted to all of them. Without their dedicated efforts and talents this book
would not have been completed. I also wish to express my appreciation to
Springer-Verlag and its staff, in particular Donatella Rizza, Executive Editor, for
the great professionalism and meticulous attention to all the details of the ed
itorial process. I am especially grateful to Rita Reggiani, Project Manager of
VI Preface
Adria Congrex, for the exceptional skill and enthusiasm in preparing the work
shop. Moreover, I would like to thank my colleagues at Umberto I Hospital, Drs.
De Piccoli, Di Pede, Bonso, Gasparini, Giada, Themistoclakis, Zuin, Rigo for
their support in the organization of the meeting and their scientific collabora
tion over the years.
Also the personal involvement and help of Gloria Leandro, Susanna
Orbolato, Stefania Damiani and other members of the secretarial and nurse
staff at my institution is sincerely appreciated. A special word of gratitude to
my mentor, professor Piccolo, whose example and advices continue to represent
an inestimable guidance and stimulus. Finally, my sincere thanks to my wife
Carmen and my children, Francesca and Michele. Their continuous encourage
ment, assistance and patience helped me during the long hours of preparing
the meeting and editing the book.
Antonio Raviele
Table of Contents
LECTURE
Progress in Arrhythmia and Sudden Cardiac Death Research Support
P. M. Spooner . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
SYNCOPE: DIAGNOSTIC, PROGNOSTIC AND THERAPEUTICAL ISSUES
Syncope or Drop Attack?
R.A. Kenny . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
Syncope or S.eizures: What Have we Learned from Electrocardiographic
Monitoring?
L. Bergfeldt . . . . . . . . . . . . . . . . . . . . . . . . . • . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
Postprandial Hypotension: Pathophysiology and Management
L.A. Lipsitz . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22
Psychogenic Syncope: How Frequent Is It?
F. Giada, A. Raviele, I. Silvestri, P. G. Nicotera, A. Rossillo, G. Leandro
and C. Ravenna . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29
Syncope with Exercise: Mechanisms and Management
D. G. Benditt . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38
The Postural Tachycardia Syndrome: Etiology, Diagnosis and Treatment
B.P. Grubb . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43
Syncope in Hypertrophic Cardiomyopathy: What are the Potential
Mechanisms and Therapeutic Implications?
S. Betocchi and F. Manganelli . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . • . . . . . . 50
Intraventricular Conduction Disturbances and Negative
Electrophysiologic Study in Patients with Syncope: What Should One Do?
C. Menozzi, N. Bottoni and M. Brignole . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57
VIII Table of Contents
Unexplained Syncope with Inducible Sustained Ventricular Arrhythmias:
to Implant or Not to Implant an I CD?
A. Raviele . . . • . . . . . . . • . . . . . . . . . . . . . . . . . . . . . . . . . • . . . . . . • . . . . . . . . . • . • . 61
Syncope and ICD: What Are the Implications and Recommendations
for Driving?
A. Jaussi, M. Fromer and L. Kappenberger . . . . . . • . . . . • . . . . • . . . . . . . . . . . . 67
Therapy of Vasovagal Syncope: Is There a Role for Drugs Today?
R. Sutton . • . • . • . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . • . . . . . . . . 75
Pacing for Vasovagal Syncope: Real Efficacy or Placebo Effect?
. R.S. Sheldon • . • . . • . . . . . • • . . . . . . . • . . . . . . . . • . . . . . . . . . . . . • . . . . . . . . . . . . 83
Prevention of Vasovagal Syncope by Pacing: How to Select Patients
and Which Pacing Mode to Choose
M. Brignole . • • . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . • . 90
CARDIAC RESYNCHRONIZATION THERAPY: WHEN, HOW AND WHY
How Many Patients Really Need Ventricular Resynchronization Therapy?
A. Boccanelli and G. Cacciatore . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 99
What Are the Clinical Benefits of Biventricular Pacing In Heart
Failure Patients?
S. Garrigue, S. Reuter, P. Bordachar, M. Hocini, P. Jai:s, M. Hai:ssaguerre
and J. Clementy . . . . . . . . . . . . . . . . . . . . . . . • . . . . . . . . . . . . . . . . . . . . . . . . . . . . 103
Neurohormonal and Anatomical Remodeling After Ventricular
. Resynchronization Therapy: Does It Really Happen?
J.P. Boehmer, J.C. Luck, D.L. Wolbrette and G. V. Naccarelli . . . . . . . . . . . . . . . . 109
Is Echocardiography Useful for Selecting Patients With Heart Failure
as Candidates for Ventricular Resynchronization Therapy?
B. De Piccoli, C. Zanella and P. Della Valentina . . . . . . . . • . . . .. . . . . . • . . . . . . 114
Is Acute Hemodynamic-Angiographic Evaluation Necessary Before
Implantation of a Left Ventricular-Based Pacemaker?
J.J. Blanc, M. Gilard, Y. Etienne, K. Touiza, M. Fatemi and J. Mansourati . . . . 121
Cardiac Resyncronization Therapy: Is There any Correlation Between Pacing
Site and Hemodynamic Improvement?
C.M.C. van Campen and H.S. Vos . . . . . . . . . . . • . . . . . . . . . . . . . . . . . . . . . . . . . 125
Does Atrial Resynchronization Confer Further Benefit on Patients
Undergoing Ventricular Resynchronization Therapy?
F. Di Pede, G. Gasparini, G. Zuin, A. Rossillo and A. Raviele . . . • . . . . . . . . . . . 134
Table of Contents IX
Ventricular Resynchronization Therapy in Heart Failure Patients
with Chronic Atrial Fibrillation: Is It Worthwhile ?
J. C. Daubert, C. Leclercq, C. Alonso and P. Mabo . . . . . . . . . . . . . . . . . . . . . • . . 140
Ventricular Resyncronization Therapy: How To Follow Implanted Patients
E. Gronda, M. Mangiavacchi, B. Andreuzzi and A. Municino ...........•. ,' 14 7
How Great Is the Arrhythmic Risk for Heart Failure Patients
and Does Resynchronization Therapy Modify It?
M.R. Gold and R. W. Peters . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . • . . . . . 151
Does Cardiac Resynchronization Therapy Diminish the Need
for Tachyarrhythmia Therapy?
S. Higgins, M. McDaniel, J. Putnam and R. Gillespie . . . . . . . . . . . • . . . . . . . . . 157
Patients Undergoing ICD Implantation:
How Many Need Biventricular Pacing?
G. Gasparini, F. Di Pede, A. Bonso, S. Themistoclakis, F. Giada, A. Corrado,
A. Rossillo and A. Raviele . . . . . • . . . . . . . . . . • . . . . . . . . . . . • . . . . . . . . . . . . . . . 163
Multisite Pacing in ICD Patients: Which Benefits?
B. Merkely and H. Va go . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . • . . . . . . . . . . . . . 170
Ventricular Resynchronization: What May we Expect
from Technological Advances?
M. Lunati, G. Magenta, G. Cattafi, R. Vecchi, M. Paolucci and
T. DiCamillo . . . . . . . • . . • . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 181
VENTRICULAR ARRHYTHMIAS AND SUDDEN DEATH: RISK STRATIFICATION
AND PREVENTION
Catecholaminergic Polymorphic Ventricular Tachycardia:
Another Inherited Arrhythmia?
C. Napolitano and S.G. Priori . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 187
The Link Between SIDS and Long QT Syndrome: from Theory to Evidence
P.J. Schwartz ....................................................... 191
Brugada Sign: What Is the Prevalence in an Apparently Healthy Population?
A. Nava, B. Bauce, S. Cannas, A. Rampazzo and B. Martini . . . . . . . . . . . . . . . . 198
Asymptomatic Patients with Brugada Syndrome: Does the Risk
of Sudden Death Justify ICD Implantation?
S. Favale and F. Nacci . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 206
Will the Spectrum of Ion Channel Diseases Increase Further
in the Near Future?
C. Napolitano and S.G. Priori ......................................... 212