Ventricular Arrhythmias in Apparently Healthy Subjects

While it is assumed that the normal heart does not predispose to serious arrhyilimias, several conditions are now being recognized as being associated with short-lasting ventricular arrhythmias. It also becomes clear that idiopathic VT (or repetitive monomorphic VT) sometimes exists on the background of a compromised heart. Whether this dysfunction is due to the arrhythmia or vice versa is not evident. Finally, VF occurs in patients who, at a first glance, have no apparent heart disease, and it is then called idiopathic VF. These complex electrical abnormalities probably reflect disorders, which often are genetically determined. Recognition of these syndromes, often characterized by abnormal repolarization or a disturbed autonomic function is possible if appropriate techniques are used.     

Effects of CPAP treatment on psychological status in patients with severe obstructive sleep apnoea

The aim of this study was to evaluate the effects of nocturnal continuous positive airway pressure (CPAP) breathing on the emotional status and cognitive function in 20 patients with severe obstructive sleep apnoea (OSA) (mean±SD apnoea/hypopnoea index=67±16, mean overnight arterial oxygen saturation=83±10%). Psychological tests were performed before, after three, and after twelve months of CPAP treatment. At initial investigation, amongst cognitive functions, the most disturbed were concentration and recent memory. The majority of subjects demonstrated increased mental stress, depression, and anxiety. Anxiety correlated with AHI ( r =0.68). Mental stress correlated with AHI ( r =0.56) and deficiency of Stage 2 NREM sleep ( r =−0.55). CPAP treatment resulted in significant improvement in cognitive function; concentration, recent verbal, visual and spatial memory were already seen at three months. No improvement in IQ and in emotional status after three months and one year of treatment was found. It is concluded that in patients with severe OSA CPAP treatment results in a significant early improvement in cognitive function but not in emotional status.     

Atrial Epicardial Pacing with Long Stimulus to P Wave Interval in a Patient with Arrhythmogenic Right Ventricular Dysplasia Complicated by Right Atrial Thrombosis

Atrial epicardial pacing with a long stimulus to P wave interval in a patient with arrhythmogenic right ventricular dysplasia complicated by right atrial thrombosis is discussed. Arrhythmogenic right ventricular dysplasia (ARVD) is associated with a high incidence of malignant ventricular arrhythmias. Most patients with ARVD need antiarrhythmic drugs, catheter ablation, or an implantable cardioverter defibrillator. We report a patient with ARVD in whom effective treatment with sotalol caused severe, symptomatic sinus bradycardia requiring permanent pacing. Due to leftward displacement of the right ventricle and the presence of two thrombi in the right atrium, an epicardial atrial lead and AAI pacemaker were implanted. A long stimulus to P wave interval caused by severe dilatation of the right atrium was recorded. During a 6 months of follow-up on sotalol treatment there were neither ventricular tachycardia (VT) attacks nor pacing problems.