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Berlin Brandenburg

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  • 1
    In: Circulation, 1992, Vol.86(4), pp.1217-1222
    Description: BACKGROUND: Shock delivery of an implantable defibrillator may cause a change in the amplitude of endocardial electrograms and impair the detection of ventricular fibrillation. Thus, the effects of shock discharges on the amplitude of endocardial electrograms were evaluated in five patients undergoing implantation of a cardioverter-defibrillator in combination with a new nonthoracotomy lead system METHODS AND RESULTS: At implant, bipolar endocardial electrograms were recorded before each shock application, during ventricular fibrillation, during redetection of ventricular fibrillation in case the applied shock was ineffective, and at intervals of 5, 10, 20, 30, 60, and 120 seconds after each shock delivery. The amplitude of the endocardial electrograms decreased from 10.5±3.8 mV during sinus rhythm to 6.3±1.9 mV during initial ventricular fibrillation and declined to 2.2±1.3 mV during redetection of ventricular fibrillation. After successful termination, the following bipolar electrograms could be obtained at the predetermined intervals: 1.9±1.2 mV, 3.1±1.8 mV, 4.5±1.9 mV, 6.5±2.9 mV, 9.5±3.3 mV, and 10.4±3.8 mV. At predischarge testing, failure of redetection of ventricular fibrillation could be documented in two patients, requiring rescue external defibrillation in both cases to restore sinus rhythm. CONCLUSIONS: These findings demonstrate that the implantable cardioverter-defibrillator did not ensure reliable redetection of ventricular fibrillation in patients using the implanted nonthoracotomy lead system. Thus, the potential risk of sudden cardiac death may persist in these patients despite defibrillator therapy.
    Keywords: Medicine ; Anatomy & Physiology;
    ISSN: 0009-7322
    E-ISSN: 15244539
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  • 2
    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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  • 3
    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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  • 4
    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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  • 5
    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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  • 6
    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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  • 7
    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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  • 8
    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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  • 9
    Language: English
    In: American Heart Journal, 1993, Vol.126(5), pp.1216-1219
    Keywords: Medicine
    ISSN: 0002-8703
    E-ISSN: 1097-6744
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  • 10
    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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