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Berlin Brandenburg

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  • 1
    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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  • 2
    In: Pacing and Clinical Electrophysiology, April 1993, Vol.16(4), pp.778-788
    Description: In a prospective study the efficacy of amiodarone in combinalion with the three Class I drugs mexiletine, fiecainide, orencainide was evaluated consecutively in 12 patients with recurrent venlriculav tachycardias (VT) by programmed stimulation. None of the tested drug combinations suppressed induction of sustained VT. The combination of amiodarone with Class IC drugs fJecainide and encainide prolonged the cycle length of VT significantly, whereas the combination with mexiletine did not hove the same degree of slowing on the VT cycle length. Several proarrhythmic effects occurred during the combination therapy with encainide: (1) frequent, spontaneous recurrences of hemodynamically well tolerated VT in four patients; (2) enhanced inducihilily of VT in three patients; (3) impaired termination of VT in three patients. Though a marked increase in QRS and QTc intervals was observed by combined treatment with encainide, no significant correlation could be established between aggravation of arrhythmia and plasma levels of encainide, degree of QRS widening, JT or QTc prolongation. The only predictor for the occurrence of proarrhythmic events was found in left ventricular ejection fraction. These findings suggest that in patients refractory to amiodarone alone or a combination with mexiletine, the combined treatment of amiodarone with other Class IC drugs prolongs the VT cycle length but does not suppress induction of VT during programmed stimulation. Combination therapy of amiodarone with encainide was associated with a high incidence of proarrhythmic effects.
    Keywords: Proarrhythmic Effects ; Antiarrhythmic Combination ; Amiodarone ; Mexiletine ; Flecainide ; Encainide
    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, July 1996, Vol.19(7), pp.1075-1081
    Description: The purpose of this study was to determine the incidence and types of venous branches and anomalies in posteroseptal accessory pathways (APs) and whether these findings are indicative for successful ablation sites. Some posteroseptal APs may be located epicardially, or may be associated with venous anomalies or related to the middle cardiac vein. These APs account for many of the failures encountered during endocardial ablation. Direct coronary sinus (CS) angiography was performed in 43 consecutive patients with left posteroseptal APs (n ‐ 23) and in 20 patients with A V nodal reentrant tachycardia prior to catheter ablation. In 14 (61%) of 23 APs, a venous branch or an anomaly of the CS was found in the posteroseptal region (6 with middle cardiac vein, 2 with other ventricular venous branches, and 6 had a diverticulum). Eleven (48%) of 23 APs were successfully abolished from within that demonstrated venous system, with a median of four radio frequency impulses. In the remaining 12 (52%) patients, ablation was attempted from the endocardial site of the mitral annulus. Repeat angiography after energy delivery revealed no major complications in any patient. One (5%) patient with AV nodal reentrant tachycardia had evidence of a CS anomaly (P 〈 0.01). Various types of venous branches and anomalies are associated with the majority of patients with left posteroseptal APs. The APs are directly related to these complex findings, and AP conduction can easily be eliminated from within the venous branches. CS angiography is suggested prior to catheter ablation of left posteroseptal APs to facilitate the ablation procedure.
    Keywords: Radiofrequency Ablation ; Accessory Pathway ; Coronary Sinus Angiography
    ISSN: 0147-8389
    E-ISSN: 1540-8159
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  • 5
    In: Pacing and Clinical Electrophysiology, April 1995, Vol.18(4), pp.743-746
    Description: Adenosine is considered to be a safe agent for termination of orthodromic atrioventricular reentrant tachycardia in patients with accessory pathways. A case with initially successful accessory pathway ablation and without preexcitation during sinus rhythm is presented, in which intravenous adenosine (6 mg) during orthodromic tachycardia was followed by atrial fibrillation and sudden onset of preexcitation with subsequent rapid ventricular response with moderate hemodynamic compromise.
    Keywords: Adenosine ; Atrial Fibrillation ; Latent Preexcitation
    ISSN: 0147-8389
    E-ISSN: 1540-8159
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  • 6
    Language: English
    In: The American Journal of Cardiology, 1992, Vol.70(11), pp.1023-1027
    Description: In a prospective and parallel, randomized study, the long-term stability of epicardial defibrillation threshold was evaluated in 22 patients, using a patch-patch lead configuration at the time of implantation and generator replacement. The concomitant antiarrhythmic drug treatment consisted of either mexiletine (720 mg/day) or amiodarone (400 mg/day) and was administered to patients in a randomized and parallel manner. During a mean follow-up of 24 +/- 6 months, the defibrillation threshold increased significantly from 14.3 +/- 2.8 to 17.9 +/- 5.3 J (p 〈 0.05) for the entire patient group. The increase in the chronic defibrillation threshold was due to a marked increase in defibrillation energy needs in the subgroup of patients receiving amiodarone. Whereas no significant change in the defibrillation threshold was documented in the subgroup of patients receiving mexiletine, the mean defibrillation threshold increased from 14.1 +/- 3.0 to 20.9 +/- 5.4 J (p 〈 0.001) in those receiving amiodarone. In all patients with increased defibrillation thresholds, reevaluation showed a reduction in the defibrillation threshold after discontinuation of antiarrhythmic drug therapy. The only variable associated with an increase in the chronic defibrillation threshold was amiodarone treatment. These findings suggest that the defibrillation threshold should be measured at each generator replacement and in case of a change in antiarrhythmic drug treatment. In particular, if amiodarone treatment is initiated, it is recommended that the defibrillation threshold should be reevaluated to ensure an adequate margin of safety.
    Keywords: Medicine
    ISSN: 0002-9149
    E-ISSN: 1879-1913
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  • 7
    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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  • 8
    Language: English
    In: The American Journal of Cardiology, 1995, Vol.76(11), pp.812-816
    Description: We investigated the physiologic heart rate (HR) to work rate (WR) relation throughout peak exercise in normal subjects as a guideline for rate-adaptive pacemaker slope programming. The study group consisted of 41 middle-aged subjects (22 men and 19 women) without evidence of cardiopulmonary disease. Peak-exercise stress tests were performed on a calibrated treadmill by using the symptom-limited "ramping incremental treadmill exercise" (RITE) protocol. The HR response, oxygen uptake, and treadmill workload increments were assessed simultaneously. The HR/WR slope, as determined using linear regression analysis, was 0.37 +/- 0.13 beats/min/W for the entire study group, which indicates an upper range increase of 5 beats/10 W increase of external treadmill work performed, using the mean value +/- 1 SD. Men generated an HR/WR slope of 0.32 +/- 0.09 beats/min/W, and women, 0.43 +/- 0.15 beats/min/W, indicating a significant sex-related difference in the HR/WR relation (p 〈 0.01). Thus, to achieve an appropriate matching of HR with patient effort, rate-adaptive pacemakers should generate an average increase of approximately 5 beats per increase in 10 W of external treadmill work. The HR/WR relation can easily be determined to provide the clinician with a minimal check system to avoid a hyper- or hypochronotropic paced response to exercise.
    Keywords: Medicine
    ISSN: 0002-9149
    E-ISSN: 1879-1913
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  • 9
    In: Pacing and Clinical Electrophysiology, January 1993, Vol.16(1), pp.198-201
    Description: Antiarrhythmic drugs are commonly used with the implantable cardioverter/defibrillator to treat recurrent ventricular tachyarrhythmias. Since various antiarrhythmic drugs have been reported to alter defibrillation threshold, an important question is whether the device will provide adequate energy for defibrillation during long‐term follow‐up and to what extent antiarrhythmic drug treatment will affect defibrillation energy requirements. To answer these questions, the defibrillation thresholds were determined in 20 patients using an epicardial patch‐patch lead configuration at the time of implantation and at the time of pulse generator replacement. During a mean follow‐up period of 24 ± 6 months, the defibrillation threshold increased significantly from 14.2 ± 3.7 joules to 18.3 ± 5.5 joules in the entire group (P 〈 0.05). This increase in defibrillation threshold was due to a marked elevation of defibrillation energy requirements in the subgroup of patients taking amiodarone compared with patients receiving mexiletine. Based on these results it is mandatory to retest defibrillation threshold at any time of pulse generator replacement to guarantee continued effectiveness. In particular, if amiodarone treatment is initiated after implantation of a defibrillator, it is recommended to reevaluate defibrillation threshold to ensure an adequate margin of safety.
    Keywords: Implantable Cardioverter Defibrillator ; Defibrillation Threshold ; Antiarrhythmic Drugs ; Amiodarone ; Mexiletine
    ISSN: 0147-8389
    E-ISSN: 1540-8159
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  • 10
    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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