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Biomedical subjects

A Geibel

Publications and source records attributed to A Geibel.

80 records · Page 5Linked to original sources
PubMed1986

Effects of early reperfusion in acute myocardial infarction on arrhythmias induced by programmed stimulation: a prospective, randomized study.

This study compares inducibility of ventricular tachyarrhythmias by programmed electrical stimulation of the heart in patients with myocardial infarction with and without reperfusion after streptokinase therapy. Sixty-two consecutive patients admitted with an acute myocardial infarction were randomized to either combined intravenous and intracoronary streptokinase (streptokinase group) or to standard coronary care unit treatment (control group). Thirty-six of the 62 patients (21 patients from the streptokinase and 15 from the control group) with a first myocardial infarction were studied by programmed ventricular stimulation after a mean of 26 +/- 14 days. No patient had a history of antiarrhythmic drug use or documentation of a ventricular arrhythmia before the initial admission. A sustained ventricular arrhythmia was induced in 10 (48%) of the 21 patients randomized to streptokinase therapy and in all 15 (100%) control patients (p less than 0.001). Sustained monomorphic ventricular tachycardia was induced in 6 (29%) and 10 (67%) patients, respectively (p less than 0.05). To terminate an induced arrhythmia, direct current countershock was required in 33% of patients in the streptokinase group and 73% of patients in the control group (p less than 0.02). Seventeen of the 21 patients treated with streptokinase and no control patient had evidence of early reperfusion 200 +/- 70 minutes after the onset of pain. In comparison with patients without early reperfusion, patients in the reperfused group had a lower maximal serum creatine kinase value (p less than 0.01), a shorter time to peak creatine kinase value (p less than 0.001) and a higher angiographic left ventricular ejection fraction (62 versus 45%, p less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1985

Determinants of prognosis in idiopathic dilated cardiomyopathy as determined by programmed electrical stimulation.

The incidence and prognostic significance of electrically induced ventricular arrhythmias were prospectively assessed in 42 patients with idiopathic dilated cardiomyopathy. All patients underwent 24-hour, long-term electrocardiographic (Holter) monitoring and 30 were analyzed by a signal-averaging vectorcardiographic procedure at entry into the study. Their response to programmed electrical stimulation during basic right ventricular pacing was investigated using 1 and 2 ventricular extrastimuli. A monomorphic tachycardia was not induced in any patient. In 36 patients (86%) polymorphic ventricular arrhythmias were initiated. Three or more induced consecutive ventricular premature complexes occurred in 9 patients (21%), nonsustained polymorphic ventricular tachycardia in 2 (4.8%) and ventricular fibrillation in 1 patient (2.4%). There was no association between electrically induced polymorphic ventricular arrhythmias and the degree of impairment of left ventricular function. Furthermore, the incidence of induced ventricular arrhythmias was not related to the Lown grade or to the total number of ventricular premature complexes during Holter monitoring. A late potential was detected by the averaged vectorcardiogram in only 1 of the 30 patients. During follow-up (mean 16 +/- 7 months) 7 patients died, 5 from chronic congestive heart failure and 2 from sudden cardiac death. No patient had an electrically induced arrhythmia of 3 or more ventricular premature complexes.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1985

Prognostic significance of repetitive ventricular response in chronic coronary artery disease.

A prospective study was conducted in 267 patients with angiographically defined coronary artery disease without documented ventricular tachycardia to determine the prognostic significance of repetitive ventricular response (RVR) after programmed electrical stimulation (PES). The patients were classified inducible if RVR with 3 or more echo beats (RVR greater than or equal to 3) could be induced. 89 patients without previous myocardial infarction (MI), 61 survivors of MI occurring between 6 weeks and 3 months before and 117 patients who had survived longer than 3 months after MI were studied. A standardized stimulation protocol with single (S1S2) and double (S1S2S3) extrastimuli during ventricular drive at a cycle length of 600, 500 and 430 ms with a current strength below 5 mA at the right ventricular apex was employed. Ventricular responses with 3 to 5 echo beats (RVR3-5) and with 6 and more echo beats (RVR greater than or equal to 6) were distinguished. In 68 (25%) patients RVR3-5 and in 38 (14%) patients RVR greater than or equal to 6 was observed; in 11 patients with RVR greater than or equal to 6 sustained VT was initiated which was monomorphic in 5 of them. The occurrence of RVR greater than or equal to 6 was related to the time interval to prior MI and most frequently found within 3 months of MI. A higher incidence of RVR greater than or equal to 6 was observed in more advanced CAD, although the angiographic findings were unable to predict the results of PES. During a mean follow up of 20 months 11 patients died, 8 suddenly, 3 in cardiac failure. Those who died had more extensive CAD, RVR greater than or equal to 3 was found in 4 of them and nonsustained VT in one. The sensitivity of RVR greater than or equal to 3 as a predictor of sudden death (SD) was 36% and the specifity 60%. The predictive value of inducibility of RVR greater than or equal to 3 as indicator of SD was 4% and the predictive value of noninducibility was 98%. It is concluded that in patients with chronic CAD without spontaneous VT, RVR with 3 more echo beats does not identify a predisposition to die suddenly.

Adult↗
PubMed1984

Long-term antiarrhythmic therapy with flecainide.

The antiarrhythmic efficacy and safety of oral flecainide were assessed during a controlled 2-week and a subsequent 48-week long-term trial. Fifteen patients with frequent (more than 30 per hour) and complex ventricular arrhythmias (Lown grade IVA or IVB) who had been resistant or intolerant to 2 or more antiarrhythmic agents, were included in the study. Antiarrhythmic efficacy was controlled by 24-hour Holter monitoring at 2, 12, 24 and 48 weeks. The administration of 100 to 200 mg flecainide twice daily resulted in more than 90% suppression of VPCs and of complex ventricular arrhythmias in 14 of 15 patients. The minimum effective therapeutic dose could be titrated in 9 of 14 patients to 100 mg twice daily, in 3 of 14 patients to 150 mg twice daily and in 2 of 14 patients to 200 mg twice daily. During this therapy and a mean plasma concentration of 886 +/- 103 ng/ml, PQ and QRS duration, as well as QTc time and JTc interval were not significantly changed. Side effects (gastrointestinal complaints, nausea, obstipation, dizziness, visual disturbances, headache and impaired potency) were seen in 5 of 14 patients after 12 weeks, in 3 of 4 patients after 24 weeks and in only 2 of 14 patients after 48 weeks. Side effects were described as mild and tolerable and did not limit flecainide therapy except in 1 patient, who had discontinued therapy with flecainide after 3 days because of intense gastrointestinal symptoms. In conclusion, flecainide is highly effective and well tolerated in the long-term treatment of serious ventricular arrhythmias.

Adult↗
PubMed1984

Incidence and clinical significance of repetitive ventricular response in patients without identifiable organic heart disease.

We determined the incidence of repetitive ventricular response (RVR) after programmed electrical stimulation and the incidence of spontaneous ventricular arrhythmias during 24 hr Holter monitoring in 38 patients in whom extensive non-invasive and invasive diagnostic tests had excluded abnormalities suggestive of organic heart disease. A standardized stimulation protocol with single (S1S2) and double (S1S2S3) extrastimuli during ventricular drive at cycle lengths of 600, 500 and 430 msec with a current strength below 5 mA at the right ventricular apex was employed. RVR occurred in 20 patients (58%) after S1S2 and in 30 patients (79%) after S1S2S3 stimulation. Eighteen patients (47%) showed RVR with 2 echo beats and 1 patient had 3 echo beats. RVR was due to bundle branch reentry (BBR) in 20 patients independent of the mode of stimulation. RVR due to intraventricular reentry (IVR) was found in 17 patients (47%) only after S1S2S3 stimulation. The incidence of both BBR and IVR was influenced by the basic ventricular driving rate, decreasing with shorter basic cycle lengths. 17 patients had no ventricular premature depolarizations (VPDs), 12 patients had uniform, 4 multiform (Lown III), 2 consecutive (Lown IVA) VPDs, and 1 patient had parasystolic rhythm. There was no relation to the incidence of repetitive ventricular response. We conclude that in patients without identifiable organic heart disease RVR with more than 2 consecutive beats is rarely found if single and double extrastimuli are employed during ventricular drive. Both bundle branch and intraventricular reentry with one or two echo beats are a common finding in this population without relation to the incidence of spontaneous ventricular arrhythmias.

Adult↗
PubMedDate not supplied

Transcatheter closure of atrial septal defects by the "buttoned" device: complications and need for surgical revision.

Immediate and medium-term experience with transcatheter closure of a secundum atrial septal defect by the "buttoned" device in seven patients is reported. Complications occurred in two patients during the procedure. In one patient with complications, the occluder was partly released in the right atrium. All efforts to correct its position were unsuccessful and caused considerable deformation of the device, which had to be removed surgically. In the other patient with complications, disconnection of the occluder and counteroccluder occurred immediately after removal of the loading wire. Both parts were retrieved by catheter. Five patients had uneventful closure of the atrial septal defect. On follow-up, however, displacement of the device towards the mitral valve was observed in two patients, which caused mitral regurgitation. Surgical removal of the device and repair of the mitral valve was necessary in both patients. Two years after the procedure, the atrial septal defect was closed completely in two of the remaining three patients and a small residual defect persisted in one patient.

Adolescent↗
PubMedDate not supplied

Imaging in cardiac mass lesions.

In 26 patients with cardiac mass lesions confirmed by surgery, diagnostic imaging was performed preoperatively by means of two-dimensional echocardiography (26 patients), angiography (12 patients), correlative computed tomography (CT, 8 patients), and magnetic resonance imaging (MRI, 3 patients). Two-dimensional echocardiography correctly identified the cardiac masses in all patients. Angiography missed two of 12 cardiac masses; CT missed one of eight. MRI identified three of three cardiac masses. Although the sensitivity of two-dimensional echocardiography was high (100%), all methods lacked specificity. None of the methods allowed differentiation between myxoma (n = 13) and thrombus (n = 7). Malignancy of the lesions was successfully predicted by noninvasive imaging methods in all six patients. However, CT and MRI provided additional information concerning cardiac mural infiltration, pericardial involvement, and extracardiac tumor extension, and should be integrated within a preoperative imaging strategy. Thus two-dimensional echocardiography is the method of choice for primary assessment of patients with suspected cardiac masses. Further preoperative imaging by CT or MRI can be limited to patients with malignancies suspected on the grounds of pericardial effusion or other clinical results.

Adult↗