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Berlin Brandenburg

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  • 1
    In: Pacing and Clinical Electrophysiology, April 1992, Vol.15(4), pp.645-648
    Description: The implantable cardioverter defibrillator is designed to prevent sudden cardiac death from ventricular tachyarrhythmias. The long-term efficacy of the implantable cardioverter defibrillator has been demonstrated by several investigators. Up to 70 % of the patients who receive an implantable cardioverter defibrillator will also be maintained on concomitant antiarrhythmic drug treatment for a variety of reasons including suppression of non-sustained ventricular tachycardia, elimination of supraventricular tachyarrhythmias, and decrease of the frequency of sustained ventricular events. Since various antiarrhythmic drugs have been reported to alter defibrillation threshold. It is a major issue to obtain more information about the chronic defibrillation threshold in patients treated by the implantable cardioverter defibrillator. This publication reports details.
    Keywords: Elektrotherapie ; Elektrische Stimulation ; Defibrillator ; Implantation (Chirurgie) ; Kenndaten ; Arzneimittelwechselwirkung ; Arzneimittel ; Reizwahrnehmung ; Tachykardie ; Ventrikel (Herzkammer) ; Medicine;
    ISSN: 0147-8389
    E-ISSN: 1540-8159
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  • 2
    In: Pacing and Clinical Electrophysiology, September 1993, Vol.16(9), pp.1815-1821
    Description: Besides surgical problems, recipierifs of implantable cardioverter defibrillators (ICDs) are faced with psychological and social adjustments. Successful ICD therapy is influenced by the patients’ perceived concerns regarding device, discharge, changes in life style, and complications. In order to assess patients’ acceptance of the ICD, the psychological profile of 57 consecutive patients was evaluated using a specifically designed questionnaire and the State Trait Anxiety Inventory (STAI). The results showed that 20 patients staled fear of ICD discharge, 12 patients revealed physical discomfort due to the device, and limited quality‐of‐life occurred in 8 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 undergo implantation if necessary. Overall, there was only a slight, but insignificant, decrease in the level of anxiety within the total patient population after ICD implantation. However, a comparison of two subgroups indicated that the state of anxiety was significantly higher in patients 5 shocks versus those 〉 50 years of age and having experienced 〈 5 shocks. In general, the acceptance of the ICD as a tool in managing life‐threatening ventricular tachyarrhythmias is high. Besides the increased survival rate, quality‐of‐life and patient acceptance are important criteria for successful ICD therapy.
    Keywords: Implantable Cardioverter Defibrillator Icd ; Patient Acceptance ; Icd Psychological And Social Aspects
    ISSN: 0147-8389
    E-ISSN: 1540-8159
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  • 3
    In: Pacing and Clinical Electrophysiology, November 1991, Vol.14(11), pp.1762-1766
    Description: The comparative efficacy of two different antitachycardia pacing techniques was evaluated in 22 consecutive patients who received the pacemaker Intertach® with an atrial electrode for drug refractory, recurrent Supraventricular tachycardia (SVT). The Intertach® has two consecutive programmable primary and secondary termination modes. The termination programs investigated were adaptive autodecremental burst pacing and adaptive decremental scanning. Atrioventricular nodal reentrant tachycardia was present in 15 patients and atrioventricular reentrant tachycardia due to Wolff‐Parkinson‐White syndrome in seven patients. The prospective comparison was arranged in a randomized, cross‐over study over a period of 12 months. To assess long‐term efficacy, diagnostic data of the pacemakers were obtained in intervals of 3 months. In addition, noninvasive programmed stimulation was performed to compare the incidence of pacing‐induced atrial fibrillation with both termination programs. During a follow‐up of 12 months the overall success rate of autodecremental burst pacing and decremental scanning was 80% and 95%, respectively. Decremental scanning was more effective in 12 patients and less successful in two patients than autodecremental burst pacing. During noninvasive electrophysiological studies, pacing induced atrial fibrillation could be documented in three often patients (30%) using autodecremental burst pacing, compared to one often patients (10%) using decremental scanning. These data suggest that decremental scanning proved to be more successful in the long‐term management of patients with recurrent S VT than autodecremental burst pacing. Furthermore, the occurrence of pacing‐induced atrial fibrillation could be documented more frequently with autodecremental burst pacing compared to decremental scanning.
    Keywords: Antitachycardia Pacing ; Supraventricular Tachycardia ; Autodecremental Burst Pacing ; Decremental Scanning
    ISSN: 0147-8389
    E-ISSN: 1540-8159
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  • 4
    In: Pacing and Clinical Electrophysiology, February 1992, Vol.15(2), pp.179-187
    Description: Long‐term antitachycardia pacing therapy with the InterTach 262–12 and 262–16 was evaluated in 32 consecutive patients (mean age 50 ± 13 years) with recurrent, drug refractory Supraventricular tachycardia. AV nodal reentrant tachycardia was present in 20 patients, Wolff‐Parkinson‐Whife syndrome in ten patients, and a reentrant tachycardia due to Mahaim fibers in one patient. During follow‐up of 39 ± 17 months, 250 persistent tachycardia episodes occurred in 22 patients. By adjusting detection and termination mode, recurrent Supraventricular tachycardia could be controlled in 19 of 32 patients (60%) by antitachycardia pacing alone. Concomitant antiarrhythmic drug therapy was required in ten of 32 patients (30%). During follow‐up antitachycardia pacing became ineffective in three patients (10%). Thus, chronic antitachycardia pacing proved to be safe and effective in selected patients with drug refractory Supraventricular tachycardia and could significantly improve quality of life by rapid termination of recurrent supraventricular tachycardia episodes.
    Keywords: Antitachycardia Pacing ; Supraventricular Tachycardia ; Microprocessor Based Pacemakers
    ISSN: 0147-8389
    E-ISSN: 1540-8159
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  • 5
    In: Pacing and Clinical Electrophysiology, December 1995, Vol.18(12), pp.2163-2172
    Description: Changes in the amplitude of endocardial electrograms after an unsuccessful shock attempt have been demonstrated to cause failure of redetection of ventricular fibrillation in patients using an integrated sense‐pace defibrillating lead system. Thus, the objective of this study was to compare the effects of defibrillator shocks on the amplitude of endocardial electrograms in 26 patients using two different nonthoracotomy systems, a previous lead (model 0062) or a redesigned version (model 0072). At implant, bipolar endocardial electrograms were obtained before each shock application, during initial detection and redetection of ventricular fibrillation in case the applied shock was unsuccessful, and during intervals of 5, 10, 20, 30, 60, and 120 seconds after each shock delivery. No significant difference was noted in endocardial amplitudes between the lead models 0062 and 0072 during baseline sinus rhythm (12.2 ± 4.6mV vs 11.4 ± 3.8 mV), and during initial ventricular fibrillation (7.0 ± 2.4 mV vs 7.6 ± 2.3 mV). During redetection of ventricular fibrillation, however, there was a significant difference (P = 0.0006) in endocardial amplitudes (3.4 ± 1.9 mV vs 6.6 ± 2.3 mV) between both leads tested. Comparing lead models 0062 and 0072, marked differences were found in endocardial amplitudes during sinus rhythm 5, 10, and 20 seconds after successful arrhythmia termination: 2.8 ± 1.9 mV vs 8.6 ± 2.9 mV (P 〈 0.0001), 4.6 ± 2.9 mV vs 9.2 ± 3.2 mV (P = 0.0007), and 6.4 ± 4.0 mV vs 10.5 ± 3.6 mV (P = 0.01). At predischarge testing, failure of redetection of ventricular fibrillation was documented in two patients with the lead model 0062 requiring external defibrillation to restore sinus rhythm. These findings demonstrate a significant less postshock attenuation of the endocardial electrogram amplitudes during persistent ventricular fibrillation after an unsuccessful shock attempt as well as during sinus rhythm immediately following an effective shock delivery using the redesigned lead system model 0072 compared to the electrogram amplitudes obtained in patients using the previous lead model 0062.
    Keywords: Implantable Cardioverter Defibrillators ; Lead Systems ; Endocardial Electrogram
    ISSN: 0147-8389
    E-ISSN: 1540-8159
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  • 6
    In: Pacing and Clinical Electrophysiology, January 1994, Vol.17(1), pp.98-102
    Description: The case of a patient with a history of myocardial infarction and recurrent ventricular tachycardia undergoing attempted radiofrequency catheter ahlation with loss of late potentials is described. Prior to energy delivery fractionated, late activation could be found using the signal‐averaged ECC despite the presence of a right bundle branch block. After successful catheter ablation, the clinical ventricular tachycardia was no longer inducible and the signal‐averaged ECG, recorded the next day, showed marked changes indicating loss of late potentials. Our report emphasizes the possibility of late potential recordings despite the presence of bundle branch block.
    Keywords: Late Potentials ; Ventricular Tachycardia ; Radiofrequency Ablation
    ISSN: 0147-8389
    E-ISSN: 1540-8159
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  • 7
    In: Pacing and Clinical Electrophysiology, November 1995, Vol.18(11), pp.2053-2061
    Description: The aim of this study was to evaluate the longterm stability of epicardial and endocardial lead systems for third‐generation cardioverter defibrillators (ICDs) and to assess the usefulness of diagnostic tools. One hundred forty patients with 61 epicardial (43.6%) and 79 nonthoracotomy systems (56.4%) were followed for 2 5 ± 19 months. A total of 18 (12.9%) lead related complications were documented. Complications of epicardial systems were detected in 10 patients (16.4%) during a follow‐up time of 36 ± 8 months: crinkling of patch electrodes in 6 patients (9.8%), insulation breakage of sensing electrodes in 2 patients (3.3%), and adapter defect in 2 patients (3.3%). Eight of the patients (10.1%) with transvenous‐subcutaneous systems had lead related complications during a 13 ± 6 months follow‐up: fracture of the subcutaneous patch lead in 2 patients (2.5%), dislodgment of the right ventricular lead in 2 patients (2.5%), dislodgment of the superior vena cava lead in 2 patients (2.5%), insulation breakage of sensing electrodes in 1 patient (1.3%), and connector defect in 1 patient (1.3%). There was no significant difference in the incidence of lead related complications between epicardial and endocardial systems (P 〉 0.05). Fractures, dislodgments, and crinklings were documented within the first 8 ± 5 months by regular chest X ray. Defects of insulation, adapter, or connector were detected 22 ± 10 months after implantation and were associated with delivery of multiple inappropriate ICD therapies. An operative lead revision was indicated for 4 epicardial (6.6%) and 6 endocardial (7.6%) lead systems. Conclusions: Endocardial lead systems offer a similar long‐term stability as compared to epicardial had systems. Chest X ray is the most useful tool to detect lead fracture, dislodgment. and patch crinkling. Marker recordings or real‐time electrograms have not been helpful in this series to identify patients with suspected lead defects prior to the experience of inappropriate ICD discharges.
    Keywords: Implantable Cardioverter Defibrillator ; Epicardial Lead System ; Endocardial Lead System ; Lead Complication
    ISSN: 0147-8389
    E-ISSN: 1540-8159
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  • 8
    In: Pacing and Clinical Electrophysiology, August 1995, Vol.18(8), pp.1549-1555
    Description: .
    Keywords: Kernspintomographie ; Herzschrittmacher ; Elektrische Stimulation ; Verträglichkeit ; Nebenwirkung ; Betriebssicherheit ; Patientensicherheit ; Modelluntersuchung ; Phantom ; Einkammer-Herzschrittmacher ; Systemvergleich ; Biotelemetrie ; Zweikammer-Herzschrittmacher ; Stimulationsbetriebsart ; Oszillographie ; Magnetisches Feld ; Medicine;
    ISSN: 0147-8389
    E-ISSN: 1540-8159
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  • 9
    In: Pacing and Clinical Electrophysiology, July 1995, Vol.18(7), pp.1374-1387
    Description: The objective of rate adaptive pacemakers that measure minute ventilation by tmnsthoracic impedance is to simulate the physiological relationship of the sensed signal to the sinus node response during exercise, thus achieving an appropriate matching of heart rate with patient effort. The purpose of this study was to determine the physiological relationship between heart rate and minute ventilation (HR/VE) during peak exercise testing in order to develop a database for appropriate rate adaptive slope programming of minute ventilation controlled pacemakers. Due to several clinical limitations of peak exercise testing, it was additionally determined whether the 35‐watt “low intensity treadmill exercise” (LITE) protocol can be used as a substitute for peak exercise test using the “ramping incremental treadmill exercise” (RITE) protocol in order to assess the correct HR/VE slope below the anaerobic threshold. The stress tests were performed on a treadmill with the collection of breath‐by‐breath gas exchange. Linear regression analysis was used to determine the HR/VE slope below and above the anaerobic threshold and during the early, dynamic phase of low intensity exercise with the RITE and LITE protocols, respectively. The results of this testing in 41 healthy subjects demonstrated that the HR/VE relationship throughout treadmill exercise using the RITE protocol was not linear but curvilinear in nature, with a steeper HR/VE slope of 1.54 ± 0.51 below versus 1.15 ± 0.37 above the anaerobic threshold (P 〈 0.005). The HR/VE slope determined during the early, dynamic phase of the LITE protocol (1.58 ± 0.88) did not differ from the HR/VE slope from rest to anaerobic threshold obtained using the peak exercise RITE test (1.54 ± 0.51; P = 0.79), Rate adaptive pacing should simulate the curvilinear relationship between heart rate and minute ventilation from rest to peak exercise. The HR/VE slope determined during the early, dynamic phase of low intensity exercise represents the HR/VE slope derived from the RITE protocol below the anaerobic threshold. According to the peak exercise database, the slope above anaerobic threshold can easily be calculated as a percentage of the slope below the anaerobic threshold. The LITE protocol can, therefore, be effectively performed as a substitute for peak exercise stress tests to determine the correct pacemaker rate response factor in order to obtain a physiological heart rate to minute ventilation relationship for the appropriate matching of paced heart rate with patient effort.
    Keywords: Rate Adaptive Pacing ; Minute Ventilation Sensor ; Sensor Algorithms ; Submaximal Exercise
    ISSN: 0147-8389
    E-ISSN: 1540-8159
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  • 10
    In: Pacing and Clinical Electrophysiology, June 1995, Vol.18(6), pp.1236-1243
    Description: . To determine the value of echocardiography for identifying coronary sinus (CS) diverticula and middle cardiac veins (MCVs) in patients with posteroseptal accessory pathways (PAPs), transthoracic (TTE) and transesophageal echocardiography (TEE) were performed in 18 consecutive patients with PAP and in 15 control subjects with left lateral accessory pathway before CS angiography. The size, shape, and location of CS diverticula and MCV were described and compared to angiography. TEE and angiography were concordant for the identification of diverticula (n = 5) and agreed for depicting MCV in 22 of the 27 cases. TTE revealed 4 of 5 diverticula and identified 4 of 27 MCV (P 〈 0.001). Fourteen MCV but no diverticula were found in the control subjects. There was no significant difference between transesophageal and angiographic measurements for the width (23.5 ± 4.9 vs 26.8 ± 6.6 mm) and height (13.5 ± 3.8 vs 15.7 ± 3.4 mm) of the diverticula, and the width (3.5 ± 0.7 vs 3.7 ± 0.6 mm) of MCV. TEE underestimated the length of the MCV (12.0 ± 1.8 vs 27.2 ± 6.0, P 〈 0.001). Delivery of radiofrequency energy within the neck of a diverticulum or within an MCV was successful in 5 of 5, and 6 of 13 cases in patients with PAPs, respectively. In conclusion, echocardiography was as reliable as angiography for detecting and describing CS diverticula and MCV in patients with preexcitation syndrome. Echocardiography is recommended prior to electrophysiological study because it may simplify radiofrequency catheter ablation.
    Keywords: Preexcitation Syndrome ; Coronary Sinus Diverticula ; Middle Cardiac Veins ; Catheter Ablation ; Echocardiography
    ISSN: 0147-8389
    E-ISSN: 1540-8159
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