RESUMEN
UNLABELLED: Episodes of atrial fibrillation occur in patients with WPW syndrome but frequently disappear after successful radiofrequency ablation. AIMS: To analyze the incidence of atrial fibrillation before and after successful ablation and the presence of increased atrial vulnerability. METHODS AND RESULTS: Fifty-four of 183 WPW patients had at least one documented episode of atrial fibrillation before ablation. During a follow-up of 24 +/- 12 months 13/54 patients (24%) experienced atrial fibrillation. At baseline, the patients with atrial fibrillation were more often men (74%) vs 53%, P=0.007), were older (45 +/- 15 vs 34 +/- 16 years, P=0.0001), more often had pre-excitation during sinus rhythm (87% vs, 73%, P=0.04) and had increased atrial vulnerability (41%, vs 18%, P<0.001). Only patients with atrial fibrillation before, developed atrial fibrillation after ablation. The 13 (of 54) patients who relapsed were also older (53 +/- 13 vs 42 +/- 15 years, P= 0.03), had increased atrial vulnerability at baseline (77% vs 29%, P=0.002), and were more symptomatic, (13 +/- 21 vs 1 +/- 3 arrhythmia attacks/month, P=0001). No patient without atrial fibrillation before ablation developed atrial fibrillation after treatment. CONCLUSIONS: The accessory pathway was important for the development of atrial fibrillation. Frequent tachycardias seem to promote an electrical remodelling and an increased atrial vulnerability to atrial fibrillation, whereas after successful ablation the majority of patients remain free of atrial fibrillation.
Asunto(s)
Fibrilación Atrial/fisiopatología , Ablación por Catéter , Síndrome de Wolff-Parkinson-White/cirugía , Adolescente , Adulto , Anciano , Niño , Técnicas Electrofisiológicas Cardíacas , Femenino , Humanos , Masculino , Persona de Mediana EdadRESUMEN
BACKGROUND: Some patients continue to have palpitations in spite of successful ablation of Wolff-Parkinson-White (WPW) syndrome. Recurrence of accessory pathways as well as unrelated arrhythmias may explain the symptoms. METHODS: We followed 194 consecutive patients after successful radiofrequency catheter ablation of overt (147) or concealed (47) WPW syndrome. The mean duration of symptoms was 16 +/- 13 years. Atrial fibrillation was documented in 54 patients (24%) prior to ablation. 185 patients responded to a questionnaire 24 +/- 12 months after ablation. RESULTS: The physical well-being was improved in 94%, unchanged in 5%, and deteriorated in 1%. However, 76 patients (39%) reported arrhythmia symptoms, in 40 patients causing pharmacological treatment (14 patients) and/or continued contact with their doctor. The underlying arrhythmias were orthodromic tachycardia (10), atrial fibrillation (12), premature beats (12), atrial flutter (1), and ventricular tachycardia (1), while in four patients no explanation was found. Minor symptoms in the other 36 patients were explained by premature beats in 29, while unexplained in 7. All patients with atrial fibrillation after ablation had atrial fibrillation before ablation. Ten relapses of WPW syndrome occurred: eight were known before the time of the questionnaire, two were confirmed at transesophageal atrial stimulation. CONCLUSION: 94% patients with a long history of tachyarrhythmias due to the WPW syndrome reported improved physical well-being after ablation, but palpitations were common during a 2-year follow-up period; 8% continued to use pharmacological antiarrhythmic treatment. Five percent had symptomatic relapses and in 6% atrial fibrillation episodes reoccurred, i.e., in half of those who had atrial fibrillation before ablation.
Asunto(s)
Arritmias Cardíacas/etiología , Ablación por Catéter , Adolescente , Adulto , Anciano , Niño , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias , Valor Predictivo de las Pruebas , Recurrencia , Encuestas y Cuestionarios , Síndrome de Wolff-Parkinson-White/complicaciones , Síndrome de Wolff-Parkinson-White/cirugíaRESUMEN
Follow-up studies on patients operated on for congenital heart defects have shown good anatomical results and long-term survival. To date, there have been few studies on such patients with regard to long-term psychosocial outcome and quality of life. In this study, two cohorts of patients operated on before the age of 15 years, one for tetralogy of Fallot (TOF) and the other for atrial septal defect (ASD), were investigated 20 and 30 years after operation regarding quality of life. The combined cohort had a higher educational level than average. There was no connection between quality of life and physical health as judged from the New York Heart Association classification. The TOF group rated their quality of life higher than the ASD group, but both groups had lower figures at the 30-year than at the 20-year follow-up. Fewer patients in the TOF than in the ASD group considered that their lives were affected by the heart disease. It is concluded that the severity of the heart disease is not necessarily congruent with estimated quality of live and that mild heart defects, such as ASD, can have a considerable impact on later life quality. Surprisingly few TOF patients were affected negatively, a finding which might reflect development of a specific coping strategy in these patients during childhood.
Asunto(s)
Defectos del Tabique Interatrial/cirugía , Calidad de Vida , Tetralogía de Fallot/cirugía , Adolescente , Niño , Preescolar , Femenino , Humanos , Masculino , Periodo PosoperatorioRESUMEN
An 81-year old man with third-degree AV block and weakness underwent an unsuccessful attempt to DDD pacemaker implant caused by hypothyroidism. Administration of thyroxin until he was euthyroid permitted implantation with normal stimulation thresholds.
Asunto(s)
Bloqueo Cardíaco/terapia , Hipotiroidismo/complicaciones , Marcapaso Artificial , Anciano , Electrocardiografía , Humanos , Hipotiroidismo/tratamiento farmacológico , Masculino , Tiroxina/uso terapéutico , Insuficiencia del TratamientoRESUMEN
A retrospective cohort study of mortality and cancer morbidity was carried out among 295 marine engineers and 182 machinists with special regard to cancer of the lung. The cohort was defined as all graduates from engineering and machinists school in Iceland during 1936-1955. During vocational training, as well as in their professional lives, marine engineers and machinists are exposed to asbestos, different kinds of mineral oils, and exhaust gases with marked individual variation as regards mode and magnitude of exposure. For deaths occurring between 1951 and 1982 information was obtained from the Statistical Bureau of Iceland. Significantly increased standardized mortality ratios were determined for cancer of the trachea, bronchus, and lung for the entire cohort. Record linkage with the Cancer Register revealed 36 cancers in the period 1955-1982. No statistically significant excess was found for the overall cancer incidence or for the incidence of cancer at any particular site. A special survey of smoking status showed that cigarette smoking was not as common among the subjects of the cohort as among the general male population in Reykjavik. These results support the suggestion that the increased mortality of lung cancer in the study group had a causal relationship to occupational exposure, particularly to asbestos exposure.