Simultaneous Independent Paroxysmal Tachycardias

Abstract

tory gastroenterostomy. The last mentioned would seem most plausible while the former two are merely conjectural. Gradman and his colleagues feel that gastro¬ enterostomy is the simplest and safest procedure, pro¬ viding that the gastric wall at the anastomotic site is nor¬ mal. We agree with this completely. In our two cases posterior gastrojejunostomy yielded excellent results. If a direct anastomosis is not feasible, then the procedure of choice is a subtotal gastric resection. SUMMARY Two cases of stenotic gastric lesions without eso¬ phageal involvement secondary to commercial hydro¬ chloric acid ingestion are reported, and attention is called to the paucity of such reports in the English literature.The relation of the quantity of gastric contents to the type and nature of gastric lesions produced is discussed, and the occurrence of postoperative hepatitis in both cases is noted.The occurrence of simultaneous independent paroxysmal tachycardias is regarded as extremely rare. It is not known, however, whether the incidence of double tachycardias is really low or only apparently so, owing to the difficulty of diagnosis because of superimposition of auricular complexes at a rapid rate on ventricular complexes. In a recent study at the Cook County Hospital we have encountered seven cases of dissociated paroxysmal tachycardias during a 10 month period. In six instances there was a paroxysmal ventricular tachycardia with a simultaneous independent paroxysmal supraventricular pacemaker. Of the supraventricular mechanisms, two were auricular tachycardia and four were auricular flutter. In the seventh case dissociated paroxysmal auricular and nodal tachycardias were present.The occurrence of auricular fibrillation with ventricular tachycardia is not infrequent, but the incidence of auricular paroxysmal tachycardia or auricular flutter with ventricular (or nodal) tachycardia is rare. In 1930 Strauss,1 reviewing the literature, found 65 cases of ventricular tachycardia, of which 21 had auricular fibrilla¬ tion. Hepburn and Rykert described two cases among 26 patients with ventricular tachycardia that occurred Dr. Richard Langendorf assisted in the interpretation of the electrocardiograms and in the preparation of this paper.The procaine amide hydrochloride ("pronestyl") added four instances of this combination in 20 cases. In 1950 Armbrust and Levine ' reported au¬ ricular fibrillation in 20 of 107 cases of ventricular tachy¬ cardia. The auricular mechanisms immediately following termination of the ventricular paroxysmal tachycardias were not recorded in the cases of Lundy and McLellan,0Scherf and Kisch,7 and Cooke and White.8 The great frequency of auricular fibrillation in cases of paroxysmal ventricular tachycardia is not surprising, since either arrhythmia may be related to coronary artery disease. In most instances the auricular fibrillation was chronic. In 2 of the 14 cases of Williams and Ellis,' however, the auricular fibrillation was paroxysmal, reverting spon¬ taneously to sinus mechanism within two weeks. In...

Interference Dissociation

“…The ventricular rate speeds up before the pause after R5, the shortest interval precedes the pause and the first cycle following the pause is greater (0.80 second) than that preceding it (0.72 second), and the pause itself is shorter than the sum of any 2 consecutive short cycles. This arrangement is typical of the Wenckebach phe- 14 shows the effect of an atrial extrasystole during interference dissociation. The fifth P wave represents an extrasystole that is conducted to the ventricle.…”

Intraventricular Concealed Double Tachycardia: A Case Report.

“…The terms, "double tachycardia" or "simultaneous tachycardias" are defined as the simultaneous occurrence of independent atrial and ventricular (or junctional) tachycardia (7,8). This type of tachycardia has been observed mainly in digitalis intoxication, generally in patients with poor left ventricular function (8)(9)(10).…”

“…Other investigators have reported intra atrial dissociation with simultaneous tachycardias as "atrial double tachycardia" (13). In these reports, double tachycardia was diagnosed by the recording of two dissociated and independent electrograms of each tachycardia (7)(8)(9)(10). If the interval of one potential was variable, various types of the second degree block between the two electrograms should be excluded.…”