Association of congenital, diffuse electrical disease in children with normal heart: sick sinus syndrome, intraventricular conduction block, and monomorphic ventricular tachycardia.

INTRODUCTION Rhythm disturbances in children with structurally normal hearts are usually associated with abnormalities in cardiac ion channels. The phenotypic expression of these abnormalities ("channelopathies") includes: long and short QT syndromes, Brugada syndrome, congenital sick sinus syndrome, catecholaminergic polymorphic ventricular tachycardia, Lènegre-Lev disease, and/or different degrees of cardiac conduction disease. METHODS The study group consisted of three male patients with sick sinus syndrome, intraventricular conduction disease, and monomorphic sustained ventricular tachycardia. Clinical data and results of electrocardiography, Holter monitoring, electrophysiology, and echocardiography are described. RESULTS In all patients, the ECG during sinus rhythm showed right bundle branch block and long QT intervals. First-degree AV block was documented in two subjects, and J point elevation in one. A pacemaker was implanted in all cases due to symptomatic bradycardia (sick sinus syndrome). Atrial tachyarryhthmias were observed in two patients. The common characteristic ventricular arrhythmia was a monomorphic sustained ventricular tachycardia, inducible with ventricular stimulation and sensitive to lidocaine. In one patient, radiofrequency catheter ablation was successfully performed. No structural abnormalities were found in echocardiography in the study group. CONCLUSION Common clinical and ECG features suggest a common pathophysiology in this group of patients with congenital severe electrical disease.

Holocene palaeoclimate and palaeovegetation on the islands of Flores and Pico

Palaeoclimatic stability is regarded as an important factor in explaining patterns of endemism in the Azorean flora. However, modelling simulations and quantitative reconstructions for the last 6000 years suggest considerable palaeoclimatic variability. Here we explore the link between Holocene palaeoclimate and palaeovegetation on the islands of Flores and Pico. Modern pollen assemblages indicate that most major plant communities can be detected using pollen analysis and that, in some cases, the pre-colonisation vegetation was quite similar to present-day relict vegetation. A 200–500-year pollen record from Alagoinha, a low-elevation mire in western Flores, shows that Juniperus brevifolia-dominated communities were widespread at lower elevations prior to large-scale deforestation. Today these communities are generally restricted to higher elevations. While our results are preliminary, there appears to be a weak link between palaeovegetation (which was primarily influenced by volcanism, soil formation and human impact) and palaeoclimatic changes detected through geochemical proxies. Even if the Azorean palaeoclimate varied substantially, its impact on the pristine vegetation, at least in terms of pollen production, was relatively small.