Prevention of recurrent sudden cardiac arrest: role of provocative electropharmacologic testing

This study evaluates the usefulness of serial provocative electropharmacologic testing for predicting the efficacy of prophylactic antiarrhythmic treatment regimens in patients resuscitated from sudden cardiac arrest in the absence of acute myocardial infarction. Testing was carried out in 34 consecutive patients (28 men and 6 women) who required cardiopulmonary resuscitation and direct current countershock for treatment of primary ventricular fibrillation (28 patients), ventricular tachycardia (5 patients) or excessively rapid heart rate during atrial fibrillation with preexcitation (1 patient).In 8 (24%) of the 34 patients, drug testing either was not feasible because of absence of inducible arrhythmia or was incomplete because of patient withdrawal from study; and 3 of these 8 patients had recurrent sudden cardiac arrest within 10 to 19 months. In an additional five patients, treatment regimens failed to prevent initiation of sustained ventricular tachyarrhythmias in the catheterization laboratory, and two of these five patients had cardiac arrest recurrences within 2 weeks to 25 months of follow-up. In the remaining 21 (62%) of the 34 patients, including 3 patients with preexcitation syndrome, a drug regimen or surgical treatment, or both, was found that prevented inducible life-threatening tachyarrhythmias in the laboratory. Subsequently, only 1 (5%) of these 21 patients died suddenly within a 7 to 38 month (mean ± standard deviation, 18 ± 8.3) follow-up period. Thus, provocative electropharmacologic testing appears to be useful in predicting response to therapy in survivors of sudden cardiac arrest

Acquired aortopulmonary fistula in acute dissection

AbstractJ Thorac Cardiovasc Surg 2001;121:1213-

Cardiopulmonary Bypass in the Sickle Cell Anemia Patient using Profound Hypothermia and Circulatory Arrest: A Case Report

A homozygous sickle cell anemia patient undergoing a pulmonary thromboendarterectomy required the use of profound hypothermia and circulatory arrest. Reports of sickling crises have been documented under conditions of hypoxemia, acidosis, hypothermia, hypovolemia, and blood trauma. This patient's management included preoperative and intraoperative exchange transfusion, increased blood flow rates and optimizing blood gas values to prevent the sickling environment. The pulmonary thromboendarterectomy surgery was successful in reducing pulmonary hypertension in this sickle cell patient. Using these techniques, no adverse sickling effects resulted from the profound hypothermia and circulatory arrest