Table Of ContentCardiac Arrhythmias 1999 -Vol. 1
Springer-Verlag Italia SrI.
Cardiac Arrhythmias 1999
Vol. 1
Edited by
Antonio Raviele
Proceedings of the
6th International Workshop
on Cardiac Arrhythmias
(Venice, 5-8 October 1999)
Lectures and Structured Symposia
, Springer
ANTONIO RAVIELE, MD
Divisione di Cardiologia
Ospedale Umberto I
Via Circonvallazione 50
1-30174 Venezia Mestre
© Springer-Verlag Italia 2000
Originally published by Springer-Verlag italia, Milan in 2000
Softcover reprint of the hardcover I st edition 2000
ISBN 978-88-470-2 178-5 ISBN 978-88-470-2139-6 (eBook)
DOI 10.1007/978-88-470-2139-6
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Preface
This book, consisting of two volumes, contains the Proceedings of the 6th
International Workshop on Cardiac Arrythmias held in Venice, Italy at the
Fondazione Giorgio Cini, on 5-8 October 1999. Over the four days of the meet
ing, practically all aspects of heart rhythm disorders were addressed and dis
cussed by internationally renowned experts and by the numerous participants
coming from all around the world. Volume 1 - which will be distributed by the
international book trade - comprises the contributions of the structured sym
posia, while Volume 2 contains those of the satellite symposia. This second vol
ume will exclusively be available to the participants of the workshop. On the
whole, I believe the book represents the state of our present knowledge about
cardiac arrhythmias and antiarrhythmic therapy.
The main topics dealt with in the two volumes include: molecular pathology
of cardiac arrhythmias; atrial fibrillation with its different pathophysiological,
electrophysiological, clinical and therapeutic aspects; atrial flutter and other
supraventricular tachyarrhythmias; ventricular arrhythmias, with particular
focus on malignant, idiopathic and uncommon forms; non-antiarrhythmic and
antiarrhythmic measures for prevention of sudden death; technological
advances and clinical aspects of ICD therapy; modern evaluation of patients
with syncope; and, finally, cardiac pacing with practical issues, controversial
indications, usefulness of different pacing modes and sites of stimulation and,
in particular, usefulness of left ventricular or biventricular pacing for treat
ment of heart failure.
Many individuals have contributed to the realization of this book. First of
all, I am indebted to the numerous Authors who dedicated a significant part of
their invaluable time in preparing excellent manuscripts. Without their enthu
siasm and personal effort this book would not have been possible. Then, I am
sincerely grateful to the Publisher, Springer-Verlag, who provided the means
for early publication of the Proceedings, with a high quality of reproduction
and clarity of content. Donatella Rizza, Executive Editor, worked with me dili
gently and tirelessly to collect and review the manuscripts. A special word of
thanks goes to my teacher, Professor Eligio Piccolo, who transmitted to me a
passion for the medical profession and for scientific research. I also wish to
acknowledge the important contributions of my colleagues, Drs. De Piccoli, Di
Pede, Bonso, Rigo, Zuin, Gasparini, Giada and Themistoclakis. Rita Reggiani
and Cristina Imola of Adria Congrex are thanked for preparing and realizing
the workshops. Their support and encouragement were essential for me.
Finally, my deepest gratitude goes to my family, Carmen, Francesca and
Michele, for their patience, personal sacrifice and continuous help.
Antonio Raviele
Table of Contents
LECTURES
Sudden Ischemic Cardiac Death: The Clinical Approach
A.Maseri ......................................................... 3
Molecular Pathology of Cardiac Diseases Liable to Cause Sudden Death
F. Calabrese, e. Basso, G. Thiene and M. Valente ........................ 6
ATRIAL FIBRILLATION
Are All Paroxysms of Atrial Fibrillation Focally Initiated?
D.C. Shah, M. Halssaguerre and P. Jals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37
How Common Is a Genetic Origin of Atrial Fibrillation?
R. Brugada, J. Brugada and R. Roberts ................................ 44
Lone Atrial Fibrillation: What Is the Anatomical and the
Electrophysiological Substrate?
G. Bagliani, M. Adam, M. Villanit, M. Pirrami, P. Franciosa, G. Carreras,
R. Apolloni, M.G. Bendini, M. Ridarelli and A.S. Montenero .............. 50
Atrial Fibrillation in Apparently Idiopathic Cardiomyopathy:
The Chicken or the Egg?
F. Morady . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58
Cardioversion for Atrial Fibrillation Today: When and Why?
C. Pandozi, G. Gentilucci, M.e. Scianaro and M. Santini. . . . . . . . . . . . . . . . . . 65
Acute Conversion of Recent -Onset Atrial Fibrillation and Flutter:
Class IC or Class III Drugs?
R.F. Guaragna, e.H. Chen and D. Bracchetti . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70
Antiarrhythmic Drug Therapy Before Electrical Cardioversion
of Atrial Fibrillation: Is It Really Useful?
A. Capucci, F.F. Tarantino, G.Q. Villani, M.F. Piepoli, D. Aschieri and A. Rosi . . . 80
VIII Table of Contents
Low-Energy Internal Defibrillation: How Many Patients Are Still in
Sinus Rhythm After 1 Year?
G. Gasparini, A. Bonso, S. Themistodakis, F. Giada, A. Corrado
and A. Raviele ..................................................... 85
How Useful Is Transoesophageal Echocardiography During Electrical
Cardioversion for Predicting Long-Term Sinus Rhythm Maintenance?
B. De Piccoli . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91
Atrial Stunning Following Sinus Rhythm Restoration: Which Mechanism,
Time Course and Implication for Anticoagulation?
F. Rigo, A. Raviele, B. De Piccoli, F. Caprioglio, C. Zanella and V. Cutaia .... 99
Drug Prevention of Atrial Fibrillation: Are Novel Agents More Effective
Than the Old Ones?
I.e.
T. Van Noord, Van Gelder and H.J.G.M. Crijns . . . . . . . . . . . . . . . . . . . . . .. 105
Atrial Pacing for Prevention of Atrial Fibrillation: Where and
How to Stimulate?
S. Saksena . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 113
Implantable Atrial Defibrillator: What are the Results of Initial Experience?
G. Gasparini, A. Bonso, S. Thernistodakis, F. Giada, A. Corrado
and A. Raviele ..................................................... 120
Implantable Atrial Defibrillator: What Are the Future Perspectives?
W. Jung, C. Wolpert, S. Herwig and B. Liideritz ......................... 125
Implantable Atrial Defibrillator: Why not a Patient-Activated Drug
Delivery System?
A. Bonso, G. Gasparini, S. Thernistodakis, F. Giada and A. Raviele 131
Ablation of Atrial Fibrillation: How Should Patients Be Selected?
F. Gaita, R. Riccardi, 1. Calo, 1. Garberoglio, M. Scaglione, 1. Coda,
P. Di Donna, R. Massa, M. Bochiardo, 1. Vivalda, S. Miceli and S. Leuzzi .. .. 136
An Anatomical Approach to Curing Atrial Fibrillation: Pulmonary Vein
Isolation with Through -the-Balloon Ultrasound Ablation
e.
M.D. Lesh, Diederich, P. Guerra, Y. Goseki and P.B. Sparks ............. 143
Ablate and Pace Therapy or AV Junction Modification for Medically
Refractory Atrial Fibrillation?
P. Della Bella, C. Tondo, C. Carbucicchio, S. Riva, A. Pro derner,
D. Facchin and P. Fioretti ....... : . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 149
Table of Contents IX
Atrial Fibrillation After Heart Surgery: How to Identify and Protect
Predisposed Patients?
C. Zussa and E. Polesel . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 156
OTHER SUPRAVENTRICULAR TACHYCARDIAS
Clinically Documented but Not Inducible Atrioventricular Nodal
Reentrant Tachycardia: To Ablate or Not To Ablate?
S.-A. Chen ........................................................ 167
Permanent Junctional Reentry Tachycardia: When to Ablate, Where
and With Which Results?
M. Lunati, G. Magenta, G. Cattafi, R. Vecchi, M. Paolucci and G. Vignati 169
How to Predict and Avoid Complete AV Block Complicating Radiofrequency
Ablation of AV Nodal Slow Pathway
P. Delise, A. Bonso, L. Coro, M. Fantine, A. Raviele,
G. Gasparini and S. Themistoclakis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 176
Ablation of Antero-Septal and Intermediate Septal Accessory Pathways:
How Safe Is It? How Can One Minimize the Risk of AV Block?
R. De Ponti, C. Storti, M. Zardini, M. Tritto, M. Longobardi,
P. Fang and J.A. Salerno-Uriarte. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 185
Acute Treatment of Atrial Flutter: Ibutilide, Transesophageal Pacing,
or DC Shock?
M. Disertori . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 193
Chronic Atrial Flutter: What Is the Risk of Thromboembolism?
N. Baldi, v'A. Russo, V, Morrone, L. Liconso and G. Polimeni ............. 198
Common and Uncommon Atrial Flutter: What Are the Long-Term
Results and Complications of Radiofrequency Ablation?
S. Gonzalez, J. Almendral, M. Ortiz, J.P. Villacastin, A. Arenal, J. Garda,
N. Perez Castellano and J.L. Delcan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 202
Atrial Tachycardia Originating from Crista Terminalis
C. Pappone, G. Oreto, M.L. Loricchio, S. Bianchi and C.D. Dicandia . . . . . . •. 212
"Incisional" Reentrant Atrial Tachycardia: How to Prevent and Treat It?
J.A. Salerno-Uriarte, M. Tritto, M. Zardini, R. De Ponti, P. Fang, C. Storti
and M. Longobardi. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 216
Treatment of Tachyarrhythmias Using Cryothermal Energy
D.L. Lustgarten, D. Keane and J. Ruskin ............................... 226
x Table of Contents
VENTRICULAR ARRHYTHMIAS
Idiopathic Ventricular Fibrillation: Is the Prognosis Always Bad?
R.N.W.HauerandC.A.Remme ...................................... 251
The Syndrome of Right Bundle Branch Block, ST Segment Elevation in
VI to V3 and Sudden Death. Are Asymptomatic patients at high risk
for sudden death?
J. Brugada, P. Brugada and R. Brugada ................................ 255
Is Atrial Vulnerability Increased In Arrhythmogenic Right Ventricular
Cardiomyopathy?
D. Corrado, G. Buja, C. Basso,A. Nava and G. Thiene .................... 262
Is Right Ventricular Outflow Tract Tachycardia a Minor Form of
Arrhythmogenic Right Ventricular Cardiomyopathy?
A. Proclemer, C. Fresco, G. Muner, M. De Cristofaro and E. Bertaglia ...... 268
Electrophysiologic Mechanisms of Polymorphic Ventricular
Tachycardia/Torsade de Pointes in the Presence of Normal or Long QT
G. Turitto and N. EI-Sherif . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 276
Sudden Infant Death Syndrome and Long-QT Syndrome:
What is Their Relationship?
H. Wedekind and G. Breithardt ...................................... 285
Brugada and Long QT Syndrome Are Two Different Diseases:
True or False?
S.G. Priori and L. Crotti . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 291
Effect of I3-Blocker Therapy on the Frequency and Type of Cardiac
Events in Patients with the Hereditary Long QT Syndrome
A.J. Moss, W. Zareba, W.J. Hall, J.L. Robinson and M.L. Andrews .......... 299
Gene Therapy for Long QT Syndrome: Fact or Fiction?
P.J. Schwartz. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 306
An Overview of Secondary Prevention Implantable
Cardioverter-Defibrillator Trials: AVID, CIDS and CASH
G. V. Naccarelli, D.L. Wolbrette, H. T. Patel, J. Dell'Orfano and J.e. Luck ..... 311
What Has Been the Impact on Clinical Practice of Recently Published
Postevent ICD Trials?
D.S. Cannom ...................................................... 319
