Cardiac Arrhythmias 1997 Springer-Verlag Italia Srl. Cardiac Arrhythmias 1997 Edited by Antonio Raviele Proceedings of the 5th International Workshop on Cardiac Arrhythmias (Venice, 7-10 October 1997) Springer ANTONIO RAVIELE, MD Divisione di Cardiologia Ospedale Umberto I Via Circonvallazione 50 l-30174 Venezia Mestre ISBN 978-88-470-2290-4 Library of Congress Cataloging-in-Publication Data International Workshop on Cardiac Arrhythmias (5th: 1997: Venice, Italy) Cardiac arrhythmias 1997: proceedings of the 5th International Workshop on Cardiac Arrhythmias, Venice, 7-10 October, 1997 I edited by Antonio Raviele. --1st ed. p. em. Includes bibliographical references and index. ISBN 978-88-470-2290-4 ISBN 978-88-470-2288-1 (eBook) DOI 10.1007/978-88-470-2288-1 1. Arrhythmias--Congresses. I. Raviele, Antonio. II. Title. [DNLM: 1. Arrhythmias--congresses. WG 330 I625c 1997] RC685.A651575 1997 616. 1'28--dc21 DNLM/DLC for Library of Congress 97-36011 CIP This work is subject to copyright. 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Product liability: The publishers cannot guarantee the accuracy of any information about dosage and application contained in this book, in every individual case the user must check such information by consulting the relevant literature. Typesetting: Graphostudio (Milan) SPIN: 10639974 Preface This book contains the Proceedings of the "sth International Workshop on Cardiac Arrhythmias" held in Venice on October 7-10, 1997. They represent an update on the most recent advances in the diagnosis, prognosis and treatment of cardiac arrhythmias; the contributions, made by numerous well-known world leaders in the field of clinical electrophysiology and arrhythmology, cover an array of timely topics including fibrillation and other supraventricular tach yarrhythmias, diagnosis and management of ventricular arrhythmias; risk strati fication and prevention of sudden death in post-myocardial infarction patients: technological advances, clinical issues and new indications of lCD therapy, update on syncope and progress in clinical pacing. I would like to express my sincere and profound gratitude to all the Authors that with enthusiasm and devotion have allowed the realization of this book. Without their effort and excellent job this volume would not have been possible. A special word of thanks also to the Publisher, Springer-Verlag, that with great expertise and care has followed the production process of the book. Finally, my deepest appreciation goes to Prof. Eligio Piccolo for his example and continuous encouragement, to my present colleagues, in particular Dr. De Piccoli, Di Pede, Rigo, Bonso, Zuin and Gasparini, for their unvaluable help in preparing and realizing the workshop and to my wife and children for their patience, per sonal sacrifice and support. Antonio Raviele The Authors wish to thank Synthelabo for the support in the realization oft his volume Table of Contents ATRIAL FIBRILLATION: MECHANISM AND CLINICAL ASPECTS . . . . . . . . 1 What Are the Electrophysiological Mechanisms of Perpetuation of Atrial Fibrillation? M.A. Allessie, F.J. Chorro, M.C.E.F. Wijffels, F. Mast and R. Dorland 3 Vagal Tone: How Important Is It in Triggering Atrial Fibrillation? A. Capucci, G.Q. Villani, D. Aschieri and A. Rosi . . . . . . . . . . . . . . . . . . . . . . . . 12 Tachycardia Induced Atrial Fibrillation: What Incidence? How to diagnose and Treat It? P. Delise, L. Coro, P. Scipione and M. Fantinel . . . . . . . . . . . . . . . . . . . . . . . . . . 18 ATRIAL FIBRILLATION: CARDIOVERSION AND DRUG PROPHYLAXIS 25 Restoration of Sinus Rhythm: Pharmacological or Electrical? M. Chimienti, S. Barbieri and G. Guazzotti . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27 Atrial Fibrillation: Which Drug to Prefer for Acute Cardioversion? N. Baldi, V.A. Russo, V. Morrone, G. Marasco and G. Polimeni . . . . . . . . . . . . 33 Drug Prevention of Paroxysmal Atrial Fibrillation, When and How? H.J.G.M. Crijns and I. C. Van Gelder . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40 Antiarrhythmic Drug Administration before Electrical Cardioversion of Atrial Fibrillation: Is It Useful to Prevent Early Arrhythmia Recurrence? G. Boriani, M. Biffi, G. Bronzetti, L. Frabetti, A. Capucci, A. Branzi and B. Magnani . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45 ATRIAL FIBRILLATION: ABLATION PROCEDURES . . . . . . . . . . . . . . . . . . . . 51 AV-Nodal Ablation versus AV-Nodal Modification for Control of Atrial Fibrillation A.P. Fitzpatrick . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53 VIII Table of Contents AV Junction Modification for Atrial Fibrillation: Which End Points? A. Bonso, S. Themistoclakis, G. Gasparini and A. Raviele . . . . . . . . . . . . . . . . 58 Heart Failure Patients with Atrial Fibrillation: How Important Is It to Regularize Ventricular Rhythm? P.E. Vardas, E.N. Simantirakis and E.G. Manios . . . . . . . . . . . . . . . . . . . . . . . . 66 Catheter Ablation of Atrial Fibrillation: Where Are We Now and Where Are We Going? M. Haissaguerre, P. Jais, D.C. Shah, M. Hocini, W. Bruszewski, A. Takahashi, S.S. Barold and J. Clementy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72 ATRIAL FIBRILLATION: INTERNAL DEFIBRILLATION . . . . . . . . . . . . . . . . . 81 Restricted or Expanded Indications for Low-Energy Internal Cardioversion? M. Santini, C. Pandozi, G. Gentilucci and M. Villani . . . . . . . . . . . . . . . . . . . . 83 Internal Atrial Defibrillation: What Are the Effects on Mechanical Function? F. Rigo,A. Raviele,B. De Piccoli, G. Gasparini,M. Ragazzo and C. Zanella . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89 Implantable Atrial Defibrillator: Which Results and Indications? W. Jung and B. Liideritz . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100 The Implantable Atrial Defibrillator: Are All the Problems Solved? S. Uvy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 110 ATRIAL FIBRILLATION: PREVENTION OF THROMBOEMBOLISM . . . . . . . 113 Atrial Fibrillation and Thromboembolic Risk: Is It Safe to Cardiovert Acutely under Heparin? M. Disertori and A. Menotti . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . 115 Prevention of Thromboembolism in Atrial Fibrillation: When Antiplatelet Agents and When Anticoagulants? G. Di Pasquale, G. Pinelli, S. Urbinati, S. Biancoli, L.G. Pancaldi, A. Pozzati, S. Vinelli, B. Sassone and F. Ottani . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 125 ATRIAL FLUTTER AND OTHER SUPRAVENTRICULAR TACHYARRHYTHMIAS. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 135 Inappropriate Sinus Tachycardia: Mechanism and Therapy C. Pappone, G. Oreto, M. Rillo and S. Chierchia . . . . . . . . . . . . . . . . . . . . . . . . 137 TableofContents IX What Is the Relationship between Atrial Fibrillation and Flutter in Man? M.D. Lesh, F.X. Roithinger, M.R. Karch, P.R. Steiner and A. SippensGroenewegen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 144 Physiology of AV Junction: What Have We Learnt from Radiofrequency Ablation? F. Gaita, R. Riccardi, M. Scaglione, L. Calo, E. Richiardi, L. Garberoglio and P. DiDonna . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 152 What Is the Clinical Significance of Ventricular Repolarization Abnormalities during Supraventricular Tachyarrhythmias? N. Paparella, G. Fuca, Y. Panayou and P. Alboni . . . . . . . . . . . . . . . . . . . . . . . . 158 Prolonged or Failed Attempts at RF Ablation of Accessory Pathways: What Are the Causes? J.A. Salerno-Uriarte, R. De Ponti, C. Storti, M. Zardini and M. Longobardi . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 166 SUDDEN DEATH RISK STRATIFICATION AFTER ACUTE MYOCARDIAL INFARCTION. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 173 What Is the Clinical and Prognostic Significance of Atrioventricular and Intraventricular Conduction Defec;ts? E. Piccolo and G. Zuin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 175 What Is the Usefulness of Ventricular Premature Beats and Ventricular Late Potentials in the Thrombolytic Era? M. Di Biase, D. De Laura, M. V. Pitzalis and P. Rizzon . . . . . . . . . . . . . . . . . . . . 183 What Is the Predictive Value of Heart Rate Variability and Baroreflex Sensitivity? R.F.E. Pedretti . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 188 Clinical Usefulness of QT Prolongation, QT Dispersion and T-Wave Alternans X. Vifiolas, A. Cabrera and A. Bayes de Luna . . . . . . . . . . . . . . . . . . . . . . . . . . . 198 Risk Stratification after Acute Myocardial Infarction: What Is the Usefulness of Programmed Ventricular Stimulation ? M. Zoni-Berisso and D. Silvestri . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 213