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Biomedical subjects

E H Simonsen

Publications and source records attributed to E H Simonsen.

8 recordsLinked to original sources
PubMed2000

Clinical experience of a new rate drop response algorithm in the treatment of vasovagal and carotid sinus syncope.

Dual chamber pacing has proven beneficial in patients with sudden drops in heart rate as seen in vasovagal syncope and carotid sinus syndrome. Newer algorithms for faster detection of an insidious drop in heart rate and short lasting intervention pacing at a high rate, as in the rate drop response algorithm in the Medtronic Kappa series of pacemakers, might improve the effect of pacing. Two case reports, that demonstrate the use of these rate drop response algorithms, are presented. A 24-year-old woman with recurrent episodes of syncope and repeated tilt-table tests with vasovagal cardioinhibitory outcomes had a Medtronic Kappa 400 pacemaker implanted. Syncope was abolished during repeat tilt-table testing following pacemaker implantation and proper functioning of the rate drop response algorithm. The patient has been free of syncope during follow-up apart from a single episode that occurred due to neglect of vasovagal warning symptoms. A 52-year-old man with coronary artery disease developed recurrent blackouts. Carotid sinus massage resulted in 5.5 s of asystole and presyncope. A Medtronic Kappa 700 pacemaker with a rate drop response algorithm was implanted and the patient became asymptomatic. The rate drop response algorithm is discussed in detail based upon the case reports, and recommendations are given for the use of this algorithm in patients with vasovagal syncope and carotid sinus syndrome.

Adult↗
PubMed1999

Efficacy and safety of intravenously administered dofetilide in acute termination of atrial fibrillation and flutter: a multicenter, randomized, double-blind, placebo-controlled trial. Danish Dofetilide in Atrial Fibrillation and Flutter Study Group.

BACKGROUND: This study was designed to assess the efficacy and safety of intravenous dofetilide in acute termination of atrial fibrillation (AF) and flutter (AFL). Dofetilide, an investigational class III antiarrhythmic agent, selectively inhibits the rapid component of the delayed rectifier potassium current, thus prolonging the effective refractory period and duration of the action potential. Dofetilide can be administered intravenously and has a rapid onset of electrophysiologic action. METHODS AND RESULTS: Ninety-six patients with AF (n = 79) or AFL (n = 17) with a median arrhythmia duration of 62 days (range 1 to 180) were randomized to placebo (n = 30) or 8 micrograms/kg IV dofetilide (n = 66) over 30 minutes. Conversion was defined as termination of the atrial arrhythmia within 3 hours from the start of infusion. The conversion rate was 30.3% after dofetilide and 3.3% after placebo (P <.006). Conversion rate was higher in AFL than in AF: 64% versus 24% (P =. 012). In nonconverters, there was no statistically significant difference between the change in heart rate among the dofetilide-treated compared with the placebo-treated patients (P =. 42). Torsade de pointes ventricular tachycardia developed in 2 patients (3%). In both patients, drug infusion was discontinued before the event because of prolongation of the QT interval. CONCLUSIONS: Intravenous dofetilide is effective in acute termination of AF and AFL of medium duration, with a particularly high efficacy rate in AFL. A small but serious risk of proarrhythmia must be anticipated.

Aged↗
PubMed1997

Impact of continuous quality improvement on selection of pacing mode and rate of complications in permanent pacing.

OBJECTIVE: To improve pacing mode selection and to reduce complications of pacing using continuous quality improvement. DESIGN: Criterion standard study. Comparison of implantations from 1992-94 with preset standards. Implementation of corrections in 1994 and re-evaluation in 1995, with one year follow up of all patients. SETTING: Tertiary hospital. PATIENTS: Consecutive patients implanted with a pacemaker from January 1992 to October 1993, 361 patients; October 1993 to June 1994, 115 patients; and January 1995 to October 1995, 140 patients. MAIN OUTCOME MEASURES: Reasons for not choosing physiological pacing and complications of pacemaker implantation. RESULTS: Most frequent reasons for not selecting physiological pacing for patients in sinus node disease were age (12.8%, 5 of 39) and technical problems (12.8%, 5 of 39); and for patients in atrioventricular block, age (31.4%, 16 of 51), and disability due to other diseases (13.7%, 7 of 51). To improve the standards, age as a sole reason for not selecting physiological pacing was disregarded and VDD pacing was introduced. Follow up showed fulfillment of standards. Cost analysis indicated minimally increased expenses of pacing hardware and no additional costs of procedures. A high rate of complications (16.2%, 77 of 476) was found related to atrial lead displacement (10.2%, 19 of 186), and to subclavian puncture from January 92-June 94. To reduce complications use of atrial screw-in leads and cephalic cut down were encouraged. Follow up showed significant reduction of complications from January 92-June 94 (77 of 476) compared with January 95-October 95 (12 of 140) (P = 0.03). CONCLUSIONS: Better compliance with international pacing guidelines was obtained by registration of reasons for deviations followed by corrections of procedures. By using screw-in leads and by using cephalic cut down the set standards were met.

Adolescent↗
PubMed1992

[Cardiac arrhythmias. Diagnosis and treatment].

This review is a task force report prepared by a working group appointed by the Danish Society of International Medicine. The report gives guidelines for the pharmacological and non-pharmacological treatment of tachyarrhythmias and bradyarrhythmias and for the referral of patients to centers with electrophysiological experience.

Arrhythmias, Cardiac↗