Biomedical subjects

D E Haines

Publications and source records attributed to D E Haines.

At least 73 records · Page 4Linked to original sources

PubMed1995

Correlation of temperature and pathophysiological effect during radiofrequency catheter ablation of the AV junction.

BACKGROUND: Accelerated junctional rhythms have been observed before the development of AV nodal block during radiofrequency (RF) catheter ablation of the AV junction. However, the time course and temperatures required to induce an accelerated junctional rhythm and AV nodal block during this procedure have not yet been characterized. METHODS AND RESULTS: Nineteen patients underwent RF ablation of the AV junction with a thermistor ablation catheter. RF energy was initially delivered at 10 W for 9 seconds and then increased by 5-W increments for 9 seconds at each power level up to a maximum power of 50 W. If a junctional rhythm was observed during the power titration, a 30- to 60-second RF application was then delivered at the same power level. The power was then further increased to a maximum of 50 W if AV nodal block was not observed after 20 seconds of RF delivery. The procedure was successful in all 19 patients. A median of one RF application (range, one to eight applications) was required to produce permanent AV nodal block. An accelerated junctional rhythm was observed during 89% of successful attempts versus 70% of unsuccessful deliveries (P = NS). The median time to onset of the junctional rhythm was significantly shorter during successful compared with unsuccessful applications (1.8 versus 7.7 seconds, respectively; P < .001). Similarly, the mean time to appearance of AV nodal block was significantly shorter during successful compared with unsuccessful attempts (19.6 +/- 9.4 versus 36.8 +/- 19.0 seconds, respectively; P < .01). The catheter tip temperatures associated with the development of an accelerated junctional rhythm were significantly lower than those associated with the appearance of AV nodal block (51 +/- 4 degrees C versus 58 +/- 6 degrees C, respectively; P < .001). Mean temperatures in the range of 60 +/- 7 degrees C were required to produce permanent AV nodal block. CONCLUSIONS: The development of an accelerated junctional rhythm within 5 seconds and the appearance of AV nodal block within 30 seconds of RF onset were both highly characteristic of successful target sites during RF ablation of the AV junction. The accelerated junctional rhythm and AV nodal block were both highly temperature dependent. The temperatures associated with the onset of AV nodal block were significantly higher than the temperatures resulting in an accelerated junctional rhythm.

Aged↗

PubMed1995

Temperature measurement as a determinant of tissue heating during radiofrequency catheter ablation: an examination of electrode thermistor positioning for measurement accuracy.

INTRODUCTION: Temperature monitoring has been proposed as a control for lesion occurrence and dimension during radiofrequency transcatheter ablation. Effective temperature measurement depends on thermistor positioning relative to the heated cardiac tissue and the convective cooling effects of the circulation. But the accuracy of a single tip thermistor as a measure of peak electrode-tissue interface temperature is unknown. METHODS AND RESULTS: A standard 8-French, 4-mm electrode catheter with 5 thermistors (1 tip thermistor, 4 radial thermistors) was used to deliver radiofrequency energy in vitro to 3 porcine right ventricles and in vivo to 7 mongrel dogs. In vitro, the catheter orientation was varied. In vivo the catheter was positioned under fluoroscopy at a variety of atrial, tricuspid annular, and ventricular sites, with no attempt to adjust catheter orientation. In both cases varied discrete power levels were used so that a wide temperature range was attained. Lesions created in vivo with a standard, single thermistor tipped electrode were compared to those of a catheter with a thermistor extending 1 mm from the tip. Power was varied and tip thermistor temperatures recorded. All lesions were examined pathologically. Comparisons of radial thermistor temperature to tip thermistor temperature for 3 catheter orientations in vitro resulted in tip thermistor underestimation of peak electrode-tissue interface temperature by a median of 0.5 degrees C in 35% of the perpendicular orientations, 1.9 degrees C in 82% of the 45 orientations, and 5 degrees C in 83% of the parallel orientations. During in vivo trials, the tip thermistor underestimated the peak electrode-tissue interface temperature during 2 of 51 lesions by 1.2 degrees C and 7.6 degrees C. There was a sudden rise in electrical impedance in 17 of 51 radiofrequency energy deliveries. Only one case was observed where the peak electrode-tissue interface temperature was below 95 degrees C. The normal to extended tip thermistor configurations analysis showed similar relationships between lesion size and temperature. CONCLUSIONS: Accuracy of a single tip thermistor was found to be dependent upon catheter-tissue orientation. With routine catheter positioning in vivo, the tip thermistor was a good indicator of peak electrode-tissue interface temperature. Thus with power regulation to avoid temperatures greater than 90 degrees C, a single flush-mounted tip thermistor is probably adequate for temperature monitoring of lesion formation and avoidance of impedance rises.

Animals↗

PubMed1995

The effect of radiofrequency catheter ablation on myocardial creatine kinase activity.

INTRODUCTION: The primary mechanism of myocardial injury during radiofrequency (RF) catheter ablation in the heart is presumed to be thermal. Creatine kinase has been measured in serum to assess the volume of myocardial injury after ablation. However, its thermal inactivation by RF ablation could lead to underestimation of the true volume of injury. METHODS AND RESULTS: Serial RF lesions were created in 10 canine left ventricles in vivo, and serial serum creatine kinase activities were measured and compared to lesion volume. To assess the stability of myocardial creatine kinase during RF catheter ablation, 29 RF ablations were made on the epicardial surface of porcine left ventricle in vivo and a 2-mm core biopsy was rapidly removed. The cores were rapidly frozen, sectioned longitudinally in 1-mm slices, and homogenized in 0.3 M Tris buffer solution containing EDTA and dithiothreitol for subsequent analysis of creatine kinase activity. An additional 19 tissue cores from RF lesions were stained and used to determine mean lesion depth. Normal tissue biopsies were exposed to 60 seconds of hyperthermia (37 degrees to 85 degrees C, n = 190), or high-density RF current at 50 degrees C (0 to 100 mA/mm2, n = 50), and tissue creatine kinase activity was measured. There was no evidence of creatine kinase washout within the first 2 hours, and peak values were measured 5 to 7 hours postablation. Tissue creatine kinase activity in the first mm depth of RF lesions averaged 10% of control values and increased over the first 5 mm of lesion depth. The mean creatine kinase activity within the hemisphere of ablated myocardium was calculated to be 31% of control. Creatine kinase activity declined significantly at temperatures above 65 degrees C, but no difference in tissue creatine kinase activity was observed among differing levels of RF current exposure in the absence of significant heating. CONCLUSIONS: Creatine kinase activity in myocardial tissue is significantly diminished within the RF lesion. Creatine kinase activity is not stable at temperatures above 65 degrees C, which are routinely achieved within the central zone of RF ablation, and is unaffected by RF current in the absence of hyperthermia. Measurements of serum creatine kinase activity after RF catheter ablation may significantly underestimate the volume of myocardial injury.

Animals↗

PubMed1995

New horizons in catheter ablation.

Catheter ablation has evolved into the dominant therapeutic modality in the treatment of a variety of arrhythmias, particularly supraventricular arrhythmias with the mechanisms of atrioventricular (AV) nodal reentry and AV reciprocating tachycardia via an accessory pathway. The mode of catheter ablation used in the great majority of cases is radiofrequency (RF) catheter ablation. This technology is well-suited for the above arrhythmias because the targets and the RF lesions are both small and discrete. Using temperature monitoring may improve the outcome of these procedures by decreasing procedure time and incidence of coagulum formation on the catheter after a sudden rise in electrical impedance. New RF catheter designs and new modalities of creating catheter-induced focal myocardial injury will allow operators to have improved success with the ablation of less approachable arrhythmias, including atrial flutter and reentrant ventricular tachycardia. Studies are currently underway to create a catheter based "maze" procedure for the treatment of atrial fibrillation. As techniques and technologies evolve, a greater proportion of patients with symptomatic or threatening arrhythmias may be approached with catheter ablation as a curative or palliative procedure.

Catheter Ablation↗

PubMed1995

Neurosurgical considerations on the anatomy of the medial canthus in children.

Craniofacial surgery and anterior skull base surgical techniques require an intimate knowledge of periorbital structures. The medial orbital anatomy is especially important for midline approaches to nasion encephalocele, midline trauma, surgery for hypertelorism as well as midline approaches to anterior skull base lesions. The medial canthal tendon is of primary importance in anchoring the eyelid medially in a cosmetic and functional fashion. This review will summarize the anatomic features of the medial canthus and its surrounding structures, including vascular and muscular components. The intimate relationship of the three components of the medial canthal tendon to the nasal lacrimal apparatus is emphasized. Techniques to prevent injury as well as to repair abnormalities in this area will be discussed.

Child↗

PubMed1995

Experimental chronic compressive cervical myelopathy: effects of decompression.

Twelve dogs developed a delayed onset of neurological abnormalities from chronic cervical cord compression that was characteristic of myelopathy. The animals were divided into two groups and matched according to degree of neurological deficit. Six animals underwent decompression through removal of the anteriorly placed compressive device. Throughout the experiment, serial neurological examinations and somatosensory evoked potential studies were performed on each animal. Spinal cord blood flow measurements were obtained during each surgical procedure and at sacrifice. Magnetic resonance images were obtained after compression and before sacrifice. All animals in the decompressed group showed significant neurological improvement after decompression; no spontaneous improvement in neurological function was seen in the compressed group. On pathological examination, irreversible changes including large motor neuron loss, necrosis, and cavitation were seen in four of the animals in the decompressed group and five in the compressed group. Cervical spondylotic myelopathy in humans is known to respond to decompression; this study provides further evidence that this animal model for chronic compressive cervical myelopathy accurately reflects the disease process seen in humans.

Animals↗

PubMed1994

Endothelial injury following experimental subarachnoid hemorrhage in rats: effects on brain blood flow.

BACKGROUND: The leading cause of death and disability in patients suffering from aneurysmal subarachnoid hemorrhage (SAH) is cerebral vasospasm, a persistent, progressive, and often irreversible constriction of cerebral arteries. A wide array of pathological changes occur in cerebral arteries following SAH, with endothelial injury being the earliest and most consistent one. Since intact endothelium modulates many reflexes that influence vascular tone, damage to them may represent a significant contributor to cerebral vasospasm. METHODS: Changes in local cerebellar blood flow (LCBF) and pathological alterations in major cerebral arteries were studied and compared in rats at various time intervals following SAH. SAH induced by the subarachnoid injection of 0.3 ml of whole blood. Sham rats received a subarachnoid injection of 0.3 ml of isotonic saline. RESULTS: Except for an immediate but transient decrease, LCBF remained unchanged over a 3 day period following saline injection. Likewise, there were no pathological alterations in cerebral arteries of saline-injected rats. In contrast, the subarachnoid injection of whole blood produced significant changes in both LCBF and cerebral arteries. Within 30 minutes post-blood injection, LCBF became significantly decreased and remained so for 4 hours. However, within 24 hours, LCBF had returned to control levels where it remained for 3 days. Endothelial injury was observed in the basilar and middle cerebral arteries from 30 minutes through 4 hours, the same periods in which LCBF was significantly reduced. Within 24 hours, the time period in which LCBF had rebounded to control ranges, cerebral arteries showed no evidence of endothelial damage and resembled control cells. CONCLUSION: The results indicate a direct correlation between changes in LCBF and the structural integrity of endothelial cells in the early stages following SAH. The lack of chronically depressed LCBF (after 1 day) may be related to the quick structural repair of endothelium.

Animals↗

PubMed1994

Intracoronary ethanol ablation in swine: characterization of myocardial injury in target and remote vascular beds.

INTRODUCTION: Physical or chemical ablation of arrhythmogenic tissue has been shown to be an effective modality of arrhythmia therapy. Chemical ablation by intracoronary infusion of ethanol into a specific coronary artery bed has been demonstrated, but the characteristics and distribution of necrosis relative to the coronary blood supply have not been delineated. METHODS AND RESULTS: A total of 40 myocardial lesions were created in 21 pigs by infusion of 1.6 +/- 0.6 mL of 50% ethanol and 50% iohexol contrast solution through a 2.7 French infusion catheter advanced into a branch of the left anterior descending or circumflex coronary artery. Prior to ethanol infusion, 5.3 +/- 1.2 mCi technetium-99m (Tc-99m) methoxyisobutyl isonitrile (sestamibi) was infused into the coronary branch in order to delineate the perfusion bed. After completion of the lesions, each heart was removed, sliced transversely in 5-mm slices, and stained with nitro blue tetrazolium in order to define the ablation bed. The slices were then imaged with a gamma camera and the area of Tc-99m sestamibi uptake was defined as the perfusion bed. These respective areas were planimetered for each slice and compared. No difference was observed in hemodynamic parameters between preablation and postablation measures except mean arterial pressure, which fell from 122 +/- 22 mmHg to 116 +/- 24 mmHg (P = 0.02). Significant ventricular arrhythmias were observed after 60% of the ablations. The mean left ventricular ejection fraction fell from 55% +/- 9% to 45% +/- 15% after completion of all ablations. The areas of the ablation beds were related to the areas of the perfusion beds but the correlation was poor (r = 0.41, P = 0.0001). Generally, the ablation bed was smaller than the perfusion bed, but evidence of ethanol reflux was observed in 29% of the lesions resulting in injury beyond the targeted perfusion bed. CONCLUSIONS: Intracoronary ethanol ablation is a promising technique for the treatment of arrhythmias. Significant arrhythmias and a decrease in left ventricular ejection fraction are associated with this technique. Lesions are generally produced within the distribution of the targeted coronary bed, but are also frequently associated with reflux to a second vascular distribution.

Animals↗

PubMed1994

Ultrastructural observations in the myocardium beyond the region of acute coagulation necrosis following radiofrequency catheter ablation.

INTRODUCTION: We hypothesized that myocardial injury following radiofrequency (RF) catheter ablation may extend beyond the region of acute coagulation necrosis as defined by histochemical staining. METHODS AND RESULTS: Five RF lesions were created in vivo in the left ventricle of two dogs using a 4-mm tipped ablation electrode in which RF power was adjusted to maintain an electrode-tissue interface temperature of 85 degrees C for 60 seconds. The lesions were bisected; one half of the lesions were stained with nitroblue tetrazolium (NBT) and the other half processed for electron microscopy. Three zones of interest were identified extending 0-3 mm, 3-6 mm, and > 6 mm from the visible pathologic lesion border. The degree of ultrastructural injury to the myocardium was scored for each zone. Electron microscopy demonstrated the presence of significant abnormalities of the plasma membrane, mitochondria, sarcomeres, sarcoplasmic reticulum, and gap junctions of myocytes, as well as damage to the microvasculature extending up to 6 mm beyond the pathologic lesion edge. The plasma membrane and gap junctions of myocytes and the microvasculature appeared particularly sensitive to thermal injury, whereas the intercalated discs were relatively thermally resistant. CONCLUSION: RF catheter ablation results in ultrastructural damage to the myocardium extending up to 6 mm beyond the acute pathologic RF lesion border as defined by NBT histochemical staining.

Animals↗

PubMed1994

Basic aspects of radiofrequency catheter ablation.

Radiofrequency (RF) catheter ablation has become the treatment of choice for many symptomatic cardiac arrhythmias. It is presumed that the primary cause of tissue injury by RF ablation is thermally mediated, resulting in a relatively discrete homogeneous lesion. The mechanism by which RF current heats tissue is resistive heating of a narrow rim (< 1 mm) of tissue that is in direct contact with the ablation electrode. Deeper tissue heating occurs as a result of passive heat conduction from this small region of volume heating. Lesion size is proportional to the temperature at the electrode-tissue interface and the size of the ablation electrode. Temperatures above 50 degrees C are required for irreversible myocardial injury, but temperatures above 100 degrees C result in coagulum formation on the ablation electrode, a rapid rise in electrical impedance, and loss of effective tissue heating. Lesion formation is also dependent on optimal electrode-tissue contact and duration of RF delivery. Newer developments in RF ablation include temperature monitoring, longer ablation electrodes coupled to high-powered RF generators, and novel ablation electrode designs.

Arrhythmias, Cardiac↗

PubMed1994

The long-term outcome of visually directed subendocardial resection in patients without inducible or mappable ventricular tachycardia at the time of surgery.

INTRODUCTION: In prior studies, 20% to 40% of patients undergoing subendocardial resection (SER) for ventricular tachycardia (VT) could not be mapped intraoperatively because the VT was either noninducible or nonmappable following the ventriculotomy. The optimal surgical approach to such patients is not known. METHODS AND RESULTS: In this study, we retrospectively compared the long-term survival and functional outcome of 29 patients with VT and prior myocardial infarction who were either noninducible or nonmappable intraoperatively and underwent a visually directed extended SER. These results were then compared to 85 patients who had inducible VT intraoperatively and underwent a map-guided sequential SER. The two patient groups had different clinical characteristics. The visually directed cohort was more likely to be male, experienced fewer VT episodes before surgery, and underwent fewer antiarrhythmic drug trials prior to resection. In addition, the visually directed group had slower VT induced at a preoperative electrophysiologic study and was less likely to present to the operating room in shock or incessant VT than the map-guided group. The postoperative VT clinical recurrence or inducibility rate was 14% in both the visually directed and map-guided groups. The long-term actuarial survival at 1, 3, and 5 years was 93%, 86%, and 75%, respectively, in the visually directed group, compared to 77%, 58%, and 58%, respectively, in the map-guided group (P = 0.06). There were no documented nonfatal recurrences of VT in either group. At 24 months following surgery, 77% of patients who had a visually directed SER were in New York Heart Association Functional Class I or II, compared to 46% of patients who underwent a map-guided SER (P < 0.05). CONCLUSION: In patients with VT and prior myocardial infarction, the inability to induce or map the VT in the operating room does not preclude a favorable long-term outcome if a visually directed extended SER technique is used.

Aged↗

PubMed1994

Intracoronary ethanol ablation in swine: effects of ethanol concentration on lesion formation and response to programmed ventricular stimulation.

INTRODUCTION: Intracoronary ethanol ablation has been successfully used as arrhythmia therapy, but the dose response of ventricular function and arrhythmogenesis to varying ethanol concentrations is undefined. METHODS AND RESULTS: Twenty-six anesthetized pigs weighing 50 +/- 11 kg underwent left and right heart catheterization. Ablation solutions composed of normal saline with ethanol in concentrations of 0%, 10%, 25%, 50%, 75%, and 100% were mixed with metrizamide, a nonionic contrast agent (3.75 g per 20 mL), then infused into branch or distal coronary arteries in each of the left anterior descending and left circumflex coronary artery distributions. Hemodynamic measurements, and coronary and left ventricular angiography were performed before and after ablation. Programmed electrical stimulation was performed preablation and at a chronic study at 4 to 6 days. Excised hearts were examined pathologically. Fifty-two lesions were created in 26 animals, and 24 animals survived to the follow-up study. Minimal hemodynamic alterations were observed in response to ablation. As the ethanol concentration of the ablation solution was increased, the prevalence of spontaneous nonsustained and sustained ventricular tachyarrhythmias increased (P = 0.0002), the ablation vessels were more persistently occluded (P = 0.028), and the postablation global left ventricular ejection fraction showed greater impairment (P = 0.002). Identifiable myocardial lesions were identified in all study groups, including those receiving the 0% ethanol infusion. Lesion size increased significantly with increasing ethanol concentration (P = 0.0004) but there was significant variance within groups. In response to programmed electrical stimulation, ventricular fibrillation was a nonspecific finding before and after ablation. In contrast, monomorphic ventricular tachycardia was induced only at postablation testing, and four of five of these animals underwent infusions with ethanol concentration of > or = 50% ethanol. CONCLUSION: Concentrations of > or = 50% ethanol are most effective in creating large ventricular lesions in intracoronary ethanol ablation, but are associated with more impairment of left ventricular function, and have a greater likelihood of acute and early chronic arrhythmia aggravation.

Animals↗

PubMed1994

Microwave catheter ablation of myocardium in vitro. Assessment of the characteristics of tissue heating and injury.

BACKGROUND: Radiofrequency (RF) catheter ablation lesion size has been limited by the small volume of tissue directly heated by the RF electrode. Microwave (MW) energy has been proposed as an alternative energy source to generate larger lesions because of its increased volume of direct tissue heating. To further characterize MW ablation of myocardium, we studied the temperature-versus-distance profiles during MW ablation in an in vitro model of perfused and superfused porcine right ventricular free wall. METHODS AND RESULTS: Radial tissue temperatures in 19 isolated porcine right ventricles were measured and recorded with four fluoroptic thermometry probes placed within the myocardium at 2.5-mm radial increments from the catheter. The MW antenna catheters used were monopolar and helical-coil antennas resonating at 915 and 2450 MHz. Durations of energy delivery for a 915-MHz MW monopolar antenna (60 to 600 seconds) and a 4-mm-tip RF electrode (60 and 300 seconds) were varied to compare time courses of lesion formation. For each lesion, the temperature at the lesion border zone (the isotherm of irreversible tissue injury) was determined. Similar lesion size and temperature profiles were observed for 915- versus 2450-MHz MW antennas and monopolar versus helical-coil MW antennas. Lesion depth for the 915-MHz monopolar antenna increased monoexponentially with a half-time of 170 seconds. The isotherms for all MW antenna designs were not significantly different. The mean isotherm of irreversible tissue injury for MW lesions was not significantly different from the mean isotherm for RF lesions (54.4 degrees C versus 53.6 degrees C, respectively). CONCLUSIONS: Microwave ablation has the potential to directly heat a greater volume of tissue than RF ablation but only with efficient MW antennas. The primary mechanism of tissue injury for both MW and RF ablation appears to be thermal.

Animals↗

PubMed1994

Effects of radiofrequency catheter ablation on regional myocardial blood flow. Possible mechanism for late electrophysiological outcome.

BACKGROUND: We postulated that the late electrophysiological effects of radiofrequency (RF) ablation may be related to microvascular injury extending beyond the region of acute coagulation necrosis. METHODS AND RESULTS: Eighteen RF lesions created in the left anterior descending coronary artery (LAD) perfusion bed of seven open chest anesthetized dogs were studied. The ablation electrode and surrounding myocardium were imaged using high-resolution two-dimensional echocardiography at x 4 magnification. After 60 seconds of RF delivery, sonicated albumin microbubbles (mean size, 4.3 microns) were injected into the LAD to measure regional myocardial perfusion, and time-intensity plots were generated from simultaneously acquired two-dimensional echocardiography images. The regions with persistent contrast effect on two-dimensional echocardiography were larger than the pathological lesions (mean cross-sectional area, 48.3 +/- 6.3 versus 19.3 +/- 4.7 mm2, respectively; P < .0001). The mean contrast transit rate in the area corresponding to the pathological lesion was 25 +/- 12% of that in the normal myocardium, but it was also reduced beyond the lesion, being 48 +/- 27% and 82 +/- 28% of normal, respectively, in the 3-mm and 3- to 6-mm circumferential rims surrounding the pathological lesion (P < .05). Electron microscopy performed in two additional dogs with similar lesions demonstrated the presence of ultrastructural damage to the microvascular endothelium well beyond the pathological lesion edge. CONCLUSIONS: RF catheter ablation not only results in a marked reduction in blood flow within the acute pathological lesion but also causes reduced flow beyond the borders of the acute lesion because of microvascular endothelial cell injury. The progression or resolution of tissue injury within the region beyond the border of the pathological lesion may explain the late electrophysiological effects of RF ablation.

Animals↗

PubMed1994

Hypothalamocerebellar and cerebellohypothalamic projections--circuits for regulating nonsomatic cerebellar activity?

Cerebellar involvement in visceral and affective responses is known from physiological and behavioral studies, but the pathways involved in these responses have remained enigmatic. Over the last ten years neuroanatomical studies have shown that the cerebellum and hypothalamus are interconnected by direct hypothalamocerebellar and cerebellohypothalamic projections and by a multitude of indirect pathways. The hypothalamocerebellar projection terminates in the cerebellar nuclei and in all layers of the cerebellar cortex as multilayered fibres. This projection is, at least in part, histaminergic. New immunocytochemical experiments indicate that small numbers of hypothalamocerebellar neurones may contain GABA- or glycine-like immunoreactivity. GABA may function as a transmitter in hypothalamocerebellar fibres, probably in conjunction with histamine, but it is not clear whether glycine may also function as a transmitter or only serve metabolic functions. The bidirectional pathways between the cerebellum and hypothalamus may be part of the circuits through which the cerebellum participates in the modulation of a variety of nonsomatic events. In addition, new observations on patients with well localized cerebellar lesions reveal simultaneous somatic and visceral dysfunction. Recent research on direct hypothalamocerebellar pathways and on other connections between hypothalamus and cerebellum is reviewed. It is hypothesized that the cerebellum may act as a general modulator and coordinator of a wide range of central nervous activities, somatic as well as nonsomatic.

Aged↗

PubMed1994

The hypothalamocerebellar projection in the cat: branching and nuclear termination.

The hypothalamic projection to the cerebellar nuclei and cortex in the cat was studied by means of retrograde transport of wheat germ agglutinin-horseradish peroxidase complex and various fluorescent tracers. The hypothalamocerebellar nuclear projection originates from various parts of the posterior hypothalamus and reaches mainly the ipsilateral fastigial and interposed nuclei, but all nuclei receive some hypothalamocerebellar fibres. It appears from our double labelling experiments that at least one half of the hypothalamocerebellar nuclear neurones by means of axon collaterals also projects to the cerebellar cortex. Experiments with depositions of fluorescent tracers in both cerebellar hemispheres show that some hypothalamocerebellar fibres branch to reach different parts of the cerebellar cortex. Previous studies have shown that hypothalamocerebellar axons may be branches of hypothalamic efferents to other sites. However, experiments with combined fluorescent tracer depositions in the cerebellum and hippocampus gave no evidence for hypothalamic neurones with axon collaterals to both these regions.

Animals↗

PubMed1993

Comparison of the usefulness of the implantable cardioverter-defibrillator and subendocardial resection in patients with sustained ventricular arrhythmias and poor regional wall motion associated with coronary artery disease.

The implantable cardioverter-defibrillator (ICD) and subendocardial resection are effective forms of therapy for sustained ventricular arrhythmias associated with coronary artery disease in selected patients. The relative efficacy of these 2 treatments in equivalently matched patients is not known. A regional wall motion score has been shown to be a powerful predictor of long-term outcome after both ICD implantation and subendocardial resection. This study retrospectively analyzed the long-term outcome of patients with coronary artery disease and ventricular arrhythmias treated during the same period with an ICD (n = 53) or by subendocardial resection (n = 65). Treatment outcomes were compared in subgroups determined by preoperative regional wall motion scores of either < or = 16 or > 16%. The 3-year cardiac mortality of the 2 therapies was not significantly different among patients with a wall motion score of > 16% (0% ICD vs 11% endocardial resection) or of < or = 16% (41% ICD vs 35% endocardial resection). Similarly, the 3-year sudden cardiac death mortality was similar among patients with a score of > 16% (0% for both ICD and endocardial resection) or of < or = 16% (9% ICD vs 14% endocardial resection, p = NS). At 24 months after hospital discharge, the percentage of patients who were in New York Heart Association functional class I or II was similar among patients with a wall motion score of > 16% (75% ICD vs 86% endocardial resection, p = NS) or with a wall motion score of < or = 16% (26% ICD vs 45% endocardial resection, p = NS).(ABSTRACT TRUNCATED AT 250 WORDS)

Cause of Death↗

PubMed1993

Use of a regional wall motion score to enhance risk stratification of patients receiving an implantable cardioverter-defibrillator.

OBJECTIVES: We postulated that preoperative assessment of both regional wall motion and left ventricular ejection fraction would serve as an accurate prognostic indicator of long-term cardiac mortality and functional outcome in patients treated with an implantable cardioverter-defibrillator. BACKGROUND: Long-term cardiac mortality has remained high in patients receiving an implantable cardioverter-defibrillator. The ability to risk stratify patients before defibrillator implantation is becoming increasingly important from a medical and economic standpoint. METHODS: The hypothesis was retrospectively tested in 74 patients who had received an implantable cardioverter-defibrillator. Left ventricular ejection fraction and regional wall motion score, derived from centerline chord motion analysis, were calculated for each patient from the preoperative right anterior oblique contrast ventriculogram. Wall motion score was the only significant independent predictor of long-term cardiac mortality and functional status by multivariate analysis because of its enhanced prognostic capability in patients with an ejection fraction in the critical range of 30% to 40%. RESULTS: Patients with an ejection fraction > 40% had a 3-year cardiac mortality rate of 0% compared with 25% for those with an ejection fraction of 30% to 40% and 48% for those with an ejection fraction < 30% (p < 0.05). Similarly, 75% of patients with an ejection fraction > 40% were in New York Heart Association functional class I or II during long-term follow-up compared with 59% of those with an ejection fraction 30% to 40% and 29% of those with an ejection fraction < 30%. Among patients with an ejection fraction of 30% to 40%, those with a wall motion score > 16% had a 3-year cardiac mortality rate of 0% compared with 71% of those with a wall motion score < or = 16% (p = 0.002). In addition, 86% of patients with a wall motion score > 16% were in functional class I or II during long-term follow-up compared with 13% of those with a wall motion score < or = 16% (p = 0.001). CONCLUSIONS: Long-term cardiac mortality and functional outcome in patients receiving an implantable cardioverter-defibrillator can be predicted if the left ventricular ejection fraction and regional wall motion score are measured preoperatively.

Activities of Daily Living↗