Zeitschrift für Kardiologie
-
Radiofrequency catheter ablation has been established as a first line therapy for the curative treatment of patients with atrioventricular nodal reentrant tachycardia and atrioventricular tachycardia encompassing accessory pathways as well as for ablation of the "normal" AV-junction. For these indications, the success rates exceed 90%. Acute complications during ablation of accessory pathway and ablation of the "normal" AV-junction occur in approximately 2-5% of patients treated. ⋯ In addition, first clinical results indicate that modification of anterograde AV-nodal conduction properties in patients with atrial fibrillation and fast ventricular rate by radiofrequency application to postero- and midseptal sites might be a useful therapeutic tool to slow ventricular rate. Because of the high success-rate and the relative low incidence of severe procedure related complications, the indications of radiofrequency ablation procedures for the treatment of supraventricular tachycardias will be extended in the future. In addition, it might be reasonable to expect that during the next years, all types of supraventricular tachycardia, except atrial fibrillation, can be targeted and cured by radiofrequency ablation in the majority of cases.
-
The term accelerated idioventricular rhythm describes an ectopic ventricular rhythm with 3 or more consecutive ventricular premature beats with a rate faster than the normal ventricular intrinsic escape rate of 30 to 40 beats per minute, but slower than ventricular tachycardia. Accelerated idioventricular rhythm differs from ventricular tachycardia by additional features such as the onset with a long coupling interval, the end by a gradual decrease of the ventricular rate or increase of the sinus rate and, last but not least, by a good prognosis. Clinically, accelerated idioventricular rhythm can occur in any form of structural heart disease and occasionally in adults or children without structural heart disease. ⋯ Its occurrence after thrombolysis during acute myocardial infarction is a marker of successful reperfusion. Since accelerated idioventricular rhythm is usually hemodynamically well tolerated and not associated with malignant ventricular tachycardias; as a rule, no specific treatment other than care of the underlying heart disease is necessary. The present overview discusses electrocardiographic criteria, possible mechanisms, and the clinical significance of accelerated idioventricular rhythms.
-
Antihypertensive therapy improves the long-term prognosis of patients with mild to moderate essential hypertension and is able to prevent complications. This is also true for the elderly patient with hypertension. ⋯ For the individual patient, the appropriate drug should be chosen on the basis of efficacy, lack of side-effects, and depending upon additional diseases, such as cardiac failure, coronary heart disease and renal failure. Only if these selection criteria are fulfilled should differences in prices of the various groups of antihypertensive agents be considered.
-
Over the past five years, the results of six prospective randomized trials have set new standards in the primary and secondary prevention of thromboembolism in "nonvalvular" ("nonrheumatic") atrial fibrillation. On the one hand, they have confirmed the increased risk of stroke in these patients amounting to about 5% per year and an annual recurrence rate after a recent transient ischaemic attack or minor stroke of 12%. ⋯ Both clinical and echocardiographic features allow the identification of subgroups at low or high risk of thromboembolic complications and provide the basis for the individual benefit-to-risk assessment of anticoagulant therapy. Aspirin is currently recommended as a second choice therapy for patients who are poor candidates for oral anticoagulants or who are considered to be at low risk for thromboembolism.
-
Cardiogenic shock is a syndrome of different etiologies resulting in the inability of the heart to provide adequate O2 delivery to peripheral organs and tissues with or without signs of severe pulmonary congestion or pulmonary edema. Clarification of the underlying etiologies is essential for prognosis and therapy. Depending on the various etiologies, the therapeutic procedure may be totally different. ⋯ Catecholamines still represent the initial first line treatment. A Swan-Ganz catheter is mandatory in such situations. In view of the rapid beta 1-receptor down-regulation induced by endogenous catecholamines, long-term administration of exogenous catecholamines (adrenalin, dopamine, dobutamine), seems essentially problematic, since these compounds intensify and accelerate this process.(ABSTRACT TRUNCATED AT 250 WORDS)