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Berlin Brandenburg

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  • 1
    Language: English
    In: American Heart Journal, 1994, Vol.127(4), pp.978-984
    Description: Es ist wichtig, die potentiellen Wechselwirkungen zwischen dem implantierbaren Kardioverter-Defibrillator (ICD) und antiarrhythmischer Therapie in Patienten zu verstehen, die als Adjunkt zur ICD-Therapie pharmakologisch behandelt werden. In der 101 Patienten umfassenden Kohortenstudie der Autoren wurden in 61 % der Patienten im Rahmen der Langzeittherapie aus folgenden Gründen Antiarrhythmika verschrieben: Unterdrückung von ventrikulären Tachykardien bzw. ventrikulären Fibrillationen (50 %), die Frequenz ventrikulärer Tachykardien zu erniedrigen (19 %), supraventrikulären Tachykardien vorzubeugen (21 %) und aus anderen Gründen (10 %). Der wichtigste Punkt ist der potentielle Einfluß von antiarrhythmischen Medikamenten auf die Defibrillationsschwelle (DFT). In Tierstudien erhöhte z.B. Lidocain in einer dosisabhängigen Weise die DFT. Quinidin, Procainamid, Propafenon und Flecainid hatten keinen Einfluß auf die DFT bzw. führten nur in wenigen Fällen zu einer geringen Zunahme. Sotalol verringerte bei interner Defibrillation die benötigte Energie. In einer prospektiven Studie konnten die Autoren belegen, daß der Einsatz von Amiodaron die DFT signifikant von 14,1 + 3,0 auf 20,9 + 5,4 J, p 〈 0.001 erhöhte (400 mg/Tag); Mexiletinin hatte keinen Einfluß (720 mg/Tag). Als Fazit schließen die Autoren, daß vor einer Gabe von antiarrhythmischen Pharmaka die DFT bzw. deren Sicherheitszone bekannt sein muß, wenn Patienten behandelt werden sollen, die einen ICD haben. Liegt nur eine geringe Sicherheitszone vor, so soll nach Beginn der Therapie die DFT neu ermittelt werden.
    Keywords: Medicine
    ISSN: 0002-8703
    E-ISSN: 1097-6744
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  • 2
    Language: English
    In: American Heart Journal, 1994, Vol.127(4), pp.1179-1184
    Description: Clinical experience suggests that the implantable cardioverter defibrillator (ICD) can reduce sudden cardiac death and total mortality in patients with malignant ventricular arrhythmia who meet the selection criteria for implantation. In addition to surgical problems, patients are faced with psychological and social adjustments. Patient acceptance for such therapy is marked by perceived concerns regarding device discharge, life-style alterations, and complications. We included 57 patients with ICDs in a study of their acceptance of the device. Results of a specially designed questionnaire (state-trait personality inventory) showed that 47 of 57 patients felt that their symptoms improved with the ICD system, 32 were constantly aware of the device, and 24 patients acclimated to the ICD system within less than 2 months. With respect to the need for battery replacement, only 27 patients requested a repeat electrophysiologic evaluation, 20 patients stated fear of ICD discharges, 12 patients revealed physical discomfort from the device, and limited quality of life occurred in eight patients. Fifty-five of 57 patients answered that it was worth having an ICD device implanted, 30 (53%) patients returned to active life, and 56 (98%) would advise another patient to have an ICD implantation if necessary. In conclusion, in general, the acceptance of the ICD as a tool for management of life-threatening ventricular tachyarrhythmias is very high. Quality of life and patient acceptance are important criteria for successful ICD therapy in addition to the improved survival rate.
    Keywords: Medicine
    ISSN: 0002-8703
    E-ISSN: 1097-6744
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  • 3
    Language: English
    In: American Heart Journal, 1993, Vol.125(3), pp.898-901
    Keywords: Medicine
    ISSN: 0002-8703
    E-ISSN: 1097-6744
    E-ISSN: 10975330
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  • 4
    Language: English
    In: American Heart Journal, 1993, Vol.126(5), pp.1216-1219
    Keywords: Medicine
    ISSN: 0002-8703
    E-ISSN: 1097-6744
    E-ISSN: 10975330
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  • 5
    Language: English
    In: American Heart Journal, 1994, Vol.127(4), pp.1086-1089
    Description: The identification of patients who benefit most from implantable cardioverter defibrillator (ICD) therapy is of great interest. To find out if clinical variables, the signal-averaged electrocardiogram, and electrophysiologic study predict occurrence of appropriate ICD discharges and death, we followed-up on 76 patients after implantation of a transvenous ICD. During a mean follow-up period of 18.2 +/- 6.4 months, 29 patients (38.6%) experienced at least one appropriate episode. When these patients were compared with those who had either no therapy or inappropriate episodes, three variables were found to be significant in the identification of patients who experienced appropriate discharges: (1) The mean ejection fraction of patients who received appropriate discharges was 35.4% +/- 13.5% versus 45.1% +/- 15.3% in the other group (p 〈 0.05); (2) patients with appropriate therapy had sustained monomorphic ventricular tachycardia that was more likely to be inducible (75.9% vs 21.2%, p 〈 0.01); and (3) in patients with appropriate therapy ventricular fibrillation was less likely to be inducible (10.3% vs 25.5%, p 〈 0.05). The signal-averaged electrocardiograms were more often abnormal, but the differences were not significant. The total mortality rate in our patient group was 7.8%, with nonsudden cardiac death in four patients, noncardiac death in one patient, and sudden death in one patient. In our patient group a lower ejection fraction and inducible sustained monomorphic ventricular tachycardia were predictors of future ICD discharge after implantation. The survival rate after transvenous ICD implantation is excellent; a longer follow-up period is necessary to further define predictors of total mortality rate.
    Keywords: Medicine
    ISSN: 0002-8703
    E-ISSN: 1097-6744
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  • 6
    Language: English
    In: American Heart Journal, 1994, Vol.127(4), pp.985-993
    Description: Bei fünf unterschiedlichen Patientengruppen, die einen implantierbaren Defibrillator bekamen, wurde eine randomisierte, prospektive Vergleichsstudie der Effektivität verschiedener Schockimpulsformen und Nicht-Thorakotomie-Elektrodenkonfigurationen durchgeführt. Bei der ersten Gruppe, bei der eine bipolare Elektrodenkonfiguration verwendet wurde, kam es zu keiner signifikanten Differenz in der mittleren Defibrillationsschwelle (DFT) zwischen simultanen und sequentiellen monophasischen Schocks (17,8 +/- 5,8 J) gegenüber (17,3 +/- 2,7 J). In der zweiten Gruppe mit bipolarer Elektrode war die mittlere DFT 21,9 plus/minus 1,3 J mit monophasischen Schocks und 14,9 +/- 5,0 J mit biphasischen Schocks (p 〈 0.001). In der dritten Gruppe mit unidirektionaler Elektrodenkonfiguration war die gemittelte DFT signifikant höher (p 〈 0.001) mit monophasischen Schocks (22,1 +/- 4,2 J) im Vergleich mit biphasischen Schocks (15,0 +/- 5,4 J). In der vierten Gruppe zeigte der intraindividuelle Vergleich mit monophasischen Schockimpulsen keine signifikanten Unterschiede in der DFT, und zwar bei bidirektionaler (21,3 +/- 5,8 J) oder bei unidirektionaler (21,7 +/- 2,6 J) Elektrodenkonfiguration. Bei der fünften Gruppe zeigte eine vereinfachte transvenöse unipolare Elektrodenkonfiguration eine signifikante geringere DFT von 9,7 +/- 3,8 J, und zwar im Vergleich mit einer standardisierten unidirektionalen Elektrodenkonfiguration (18,0 +/- 6,8 J). Das Fazit der Autoren ist: 1. es scheint keinen Unterschied in der DFT zwischen simultanen und sequentiellen Schocks zu geben; 2. biphasische Impulsformen benötigen weniger Energie als korrespondierende monophasische Impulsformen; 3. das unipolare Einzelelektroden-Defibrillationssystem ist einfach zu implantieren und liefert DFTs bei Energie, die vergleichbar einem epikardialen System sind.
    Keywords: Medicine
    ISSN: 0002-8703
    E-ISSN: 1097-6744
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  • 7
    Language: English
    In: American Heart Journal, 1994, Vol.127(4), pp.1026-1030
    Description: The objective of minute ventilation (MV)-controlled pacemaker algorithms is to simulate the physiologic relationship of the sensed signal and the sinus node response during exercise. In our study we determined the relationship between heart rate and MV in healthy middle-aged subjects by measuring breath-by-breath gas exchange throughout peak exercise. Regarding several clinical limitations of peak exercise testing, we additionally evaluated whether a 35 W low-intensity treadmill exercise (LITE) protocol can be used as a substitute for peak exercise testing to determine the physiologic heart rate to MV slope. The results demonstrated that the heart rate to MV relationship is not linear throughout peak exercise but is curvilinear with a smooth logarithmic-type profile. To simulate this relationship, MV-based rate adaptive pacemakers should generate a decreasing heart rate to MV slope during higher levels of work. The heart rate to MV slope determined during the early, dynamic phase of low-intensity exercise represents the same slope derived from peak exercise below the anaerobic threshold. The low-intensity treadmill exercise protocol, with minimal patient effort, can thus be used as a substitute for peak exercise to optimize rate adaptive slope programming of MV-controlled pacemakers.
    Keywords: Medicine
    ISSN: 0002-8703
    E-ISSN: 1097-6744
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  • 8
    Language: English
    In: American Heart Journal, 1994, Vol.127(4), pp.1073-1080
    Description: Treatment of resuscitated patients with implantable cardioverter defibrillators has become increasingly more common as a method for the prevention of sudden cardiac death. Major complications such as perioperative death (incidence 2% to 8%), infection (2% to 11%); and lead-related problems (3% to 27%) have been described in previous trials. In our experience with 140 patients, problems were related to leads (n = 11), the device (n = 2), pacing (n = 1), sensing (n = 13), and defibrillation function (n = 5). Additional problems that occurred during the perioperative period included infection (n = 11), hematoma, and seroma (n = 2). Thrombus formation along endocardial leads was observed in 13 of 62 (21%) patients. Different arrhythmias (n = 10), such as sinus tachycardia, atrial fibrillation, and nonsustained, slow or incessant ventricular tachycardia with shock delivery, were also detected. Surgical management (predominantly for the major problems) was used in 31 (48%) patients, drug treatment in 25 (39%), and reprogramming of the device in 24 (38%) patients. All of these problems can result in an increase in mortality rates. This article provides an overview of the complications of cardioverter defibrillator treatment and is based on both published data and our series.
    Keywords: Medicine
    ISSN: 0002-8703
    E-ISSN: 1097-6744
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