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There have been relatively few studies on the relationship between recent perceived environmental stress and cognitive performance, and the existing studies do not control for state anxiety during the cognitive testing. The current study addressed this need by examining recent self-reported environmental stress and divided attention performance, while controlling for state anxiety. Fifty-four university undergraduates who self-reported a wide range of perceived recent stress (10-item perceived stress scale) completed both single and dual (simultaneous auditory and visual stimuli) continuous performance tests. Partial correlation analysis showed a statistically significant positive correlation between perceived stress and the auditory omission errors from the dual condition, after controlling for state anxiety and auditory omission errors from the single condition (r = 0.41). This suggests that increased environmental stress relates to decreased divided attention performance in auditory vigilance. In contrast, an increase in state anxiety (controlling for perceived stress) was related to a decrease in auditory omission errors from the dual condition (r = - 0.37), which suggests that state anxiety may improve divided attention performance. Results suggest that further examination of the neurobiological consequences of environmental stress on divided attention and other executive functioning tasks is needed.

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Bundle branch reentrant ventricular tachycardia (BBRVT) has a suitable anatomic substrate for radiofrequency catheter ablation. However, the experience with this treatment is still small. In the current study, we examined the safety and the long-term efficacy of radiofrequency ablation in the cure of patients with BBRVT. Four patients with BBRVT, identified during electrophysiological study, underwent temperature-controlled radiofrequency ablation of the right bundle branch (RBB). All of them had syncope and structural heart disease with reduced left ventricular ejection fraction. The baseline examination revealed an intraventricular block, prolonged HV interval and inducible sustained VT because of bundle branch reentry in all patients. RBB was successfully abolished in all patients after the delivery of 3 +/- 1 radiofrequency pulses. After ablation, a permanent pacemaker was implanted in one patient with significantly prolonged HV interval. All patients were free of BBRVT during a mean follow-up of 20 months. One patient received implantable cardioverter-defibrillator for myocardial VT five months after ablation. Two patients developed congestive heart failure. Radiofrequency catheter ablation of the RBB is a safe and highly effective therapeutic procedure for definitive cure of BBRVT. Long-term prognosis of these patients depends mainly on the underlying heart disease and the treatment of other VT.

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UNLABELLED: The value of nonfunctional infrahisal second-degree atrioventricular (AV) block induced by incremental atrial pacing was prospectively examined in 192 patients with chronic bundle branch block (BBB) and syncope. We compared 174 (91%) patients with normal response to atrial pacing (Group I) to 18 (9%) patients with atrial pacing induced nonfunctional infrashisal second-degree AV block (Group II). Patients in group I had higher incidence of organic heart disease, ventricular tachycardia induction, and retrograde ventriculoatrial conduction (P < 0.001, P < 0.05, P < 0.01, respectively), while patients in group II had higher incidence of primary conduction disease and prolonged H-V intervals (P < 0.001, P < 0.01, and P < 0.001). During mean follow-up period of 65 +/- 34 months for group I, and 68 +/- 35 months for group II, a development of spontaneous second- or third-degree AV block was higher in group II (14/18 [78%]), than in group I (15/174 [9%]) (P < 0.001). The site of AV block was infrahisal in all patients in group II, and in 10 of 15 patients in group I. Because of the prophylactic pacing in all patients in group II, the incidence of sudden death was similar among the two groups, but patients in group I had higher incidence of cardiac death (P < 0.05). CONCLUSION: In patients with chronic BBB and syncope, a nonfunctional infrashisal AV block induced by incremental atrial pacing identified patients with particularly high risk of development of spontaneous infrahisal AV block. Therefore, permanent cardiac pacing is absolutely indicated in these patients.

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Non-invasive diagnostic methods (history, ECG, phonocardiography, exercise testing, Holter monitoring and Doppler echocardiography) were done in 48 persons with mitral valve prolapse (MVP). The aim was to establish possible risk factors for occurrence of ventricular tachycardia (VT) in persons with MVP and to find a possible difference between these risk factors. The possible risk factors for VT are: syncope, negative T wave in the inferolateral ECG leads, longer duration of QT interval, ST devalvation and duration of the ST devalvation, reduction of oxygen consumption evaluated by exercise testing, left ventricular function impairment, polymorphic premature ventricular contractions (PVC's), paired PVC's, larger dimensions of left cardiac chambers, larger surface and thickness of anterior mitral leaflet, extent of mitral regurgitation and higher mitral valve prolapse score. In patients with sustained VT we found higher age, more frequent syncopal attacks, longer QTc interval, more frequent negative T wave in inferolateral ECG leads, deeper ST devalvations, lower oxygen consumption, more prominent left ventricular function impairment, more frequent polimorphic PVC's (more than 10/1000 ventricular complexes), paired PVC's and thicker anterior mitral leaflet than in patients with non-sustained VT. (For all these risk factors is p < 0.01). Non-invasive diagnostic methods could help to identify the patients with mitral valve prolapse at elevated risk for VT.

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In the last ten years different forms of nonpharmacological therapy of supraventricular tachyarrhythmias were developed. One of the major advances is the catheter fulguration, which has reduced significantly need for surgical procedures in the treatment of atrial or junctional tachyarrhythmias. Operative treatment for dissection or ablation of accessory atrioventricular pathways is currently highly successful with minimal morbidity in any pathway location. The use of an antitachycardia pacemaker is limited to some reentrant tachycardias. The choice of nonpharmacological therapy is strongly individual and depends on the type and etiologic underlaying of supraventricular tachyarrhythmia.

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Seventeen patients with dilated cardiomyopathy (mean ejection fraction 22%) in the NYHA state III or IV were investigated. All patients fulfilled the criteria of an indication for administration of furosemide, since left ventricular filling pressure (LVFP, measured as pulmonary capillary pressure) was 20 or more mm Hg in all. This study investigates the effects of an acute (40 mg i.v.) administration of furosemide (observation period 0 to 90 minutes after administration). Conventional M-mode, 2-dimensional and Doppler-echocardiography was performed in all patients. Patients were divided into 2 groups according to the degree of (relative) mitral regurgitation (MR): group 1 with moderate to severe (n = 10) and group 2 with mild or no MR (n = 7), 90 minutes after administration of furosemide LVFP decreased by 76%. In group 1 this occurred together with a 23% rise of cardiac index and a fall of systemic vascular resistance of 21%. In group 2 cardiac index decreased by 22% with a rise of systemic vascular resistance of 14%. The chronic oral administration of furosemide over 4 weeks ameliorated the NYHA state of all patients by one grade. We conclude from our results that patients with advanced dilated cardiomyopathy profit only from acute administration of furosemide if a significant (relative) MR is present also. A low dose chronic oral administration of the drug, however, leads in any case to clinical amelioration.

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