1/2. syncope and tumours in the neck: carotid sinus or glossopharyngeal syndrome?Three patients with syncope, lateral cervical metastasis and/or carotid sinus hypersensitivity are described. The initial diagnosis in these patients was carotid sinus syndrome (CSS). Further investigations, including computerized tomography, showed in all the patients a malignant tumour localized in the epipharynx or nearby. We think that the symptomatology in our patients can be attributed to the epipharyngeal tumour. The mechanism of the attacks could be similar to that which operates in the glossopharyngeal neuralgia-asystole syndrome, but does not involve pain pathways. The clinical picture in our patients was quite different from the classic CSS; the vaso-vagal attacks were more prolonged, severe, and relapsing and were mainly vasodepressor. Symptoms were not improved by demand ventricular pacing, but A-V sequential pacing achieved a moderate improvement in two patients.- - - - - - - - - - ranking = 1keywords = near (Clic here for more details about this article) |
2/2. Radiofrequency catheter ablation of idiopathic left ventricular tachycardia: further evidence for microeentry as the underlying mechanism.INTRODUCTION: Idiopathic left ventricular tachycardia with a QRS pattern of right bundle branch block and left-axis deviation constitutes a rare but electrophysiologically distinct arrhythmia entity. The underlying mechanism of this tachycardia, however, is still a matter of controversy. This report describes findings in a 42-year-old man who underwent successful radiofrequency catheter ablation of idiopathic left ventricular tachycardia. methods AND RESULTS: On electrophysiologic study, the tachycardia was reproducibly induced and terminated with double ventricular extrastimuli. Intravenous verapamil terminated the tachycardia whereas adenosine did not. Detailed left ventricular catheter mapping during sinus rhythm revealed a fragmented delayed potential at the mid-apical region of the inferior site near the posterior fascicle of the left bundle branch. At the same site, continuous electrical activity throughout the entire cardiac cycle was recorded during ventricular tachycardia. Repeated spontaneous termination of this continuous electrical activity in late diastole was followed immediately by termination of the tachycardia. Single application of radiofrequency current for 20 seconds at this site completely abolished inducibility of the tachycardia. After catheter ablation, at the identical site of preablation recording of the fractionated potential during sinus rhythm, no fragmented delayed activity could be recorded. There was no complication from the ablation procedure. CONCLUSION: The preablation recordings of fragmented delayed potentials during sinus rhythm and continuous diastolic electrical activity during tachycardia, together with ablation characteristics and previously reported electrophysiologic properties of this arrhythmia, may further support microreentry as the underlying mechanism in idiopathic left ventricular tachycardia.- - - - - - - - - - ranking = 1keywords = near (Clic here for more details about this article) |