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F H Wittkampf

Publications and source records attributed to F H Wittkampf.

31 records · Page 2Linked to original sources
PubMed1994

Bradycardia dependent QT prolongation and ventricular fibrillation following catheter ablation of the atrioventricular junction with radiofrequency energy.

Recurrent ventricular fibrillation was observed in a 67-year-old woman following catheter ablation of the AV junction using radiofrequency energy. This serious complication has been reported following direct current energy ablation of the AV junction, but not after using radiofrequency energy. This life-threatening arrhythmia seemed pause and bradycardia dependent. It was followed by QTc prolongation of the QRS escape rhythm 1 day after the procedure. Ventricular arrhythmias were suppressed by rapid ventricular pacing.

Aged↗
PubMed1994

Unipolar electrogram models for prediction of outcome in radiofrequency ablation of accessory pathways.

Meticulous catheter positioning close to the accessory pathway is essential for successful radiofrequency ablation. The aim of this study was to identify local unipolar electrogram characteristics predictive of radiofrequency ablation outcome, enabling more accurate accessory pathway localization and catheter positioning. So far mainly bipolar electrogram parameters have been evaluated, stressing the importance of the presence of an accessory pathway potential. However, especially in the absence of this parameter, the unipolar recording mode can be expected to hold several advantages. Nine local unipolar electrogram characteristics were analyzed in preexcited sinus rhythm directly preceding radiofrequency pulses in 35 consecutive patients with a manifest accessory atrioventricular pathway. A total of 1,230 unipolar electrogram complexes were analyzed and recorded at 138 ablation sites. Ablation was successful in 30/35 patients (86%). Multivariate analysis provided two unipolar models for prediction of ablation outcome: in Model I, sites with a suspected accessory pathway potential, local AV interval < or = 30 msec and catheter stability had 76% probability of success, but no more than 1% in their absence. In contrast, using the bipolar recording mode, presence of a suspected accessory pathway potential was the only one of these parameters shown to differentiate between successful and unsuccessful sites, with a predicted chance of success of 48%. Model II, not requiring assessment of possible accessory pathway potentials, showed a 63% probability of success for the combination of initial positivity of the local ventricular signal < or = 0.1 mV, AV interval < or = 30 msec, and catheter stability, but no more than 7% in their absence. Moreover, gradual decrease of initial ventricular positivity and AV interval while approaching a subsequently successful site allows the use of these parameters as dynamic mapping tools. Local unipolar electrogram parameters may thus facilitate precise accessory pathway localization and catheter positioning while offering important information supplementary to the bipolar mode, and enable accurate prediction of ablation outcome at a given site also in the absence of accessory pathway potential recording.

Adolescent↗
PubMed1994

In vivo ventricular lesion growth in radiofrequency catheter ablation.

While radiofrequency catheter ablation has proved highly effective in the treatment of various supraventricular tachyarrhythmias, results in the treatment of ventricular tachycardia invite improvement. Knowledge of lesion growth in vivo might improve understanding of this discrepancy. So far only information from in vitro and in vivo studies using a small 2 mm tip electrode is available. Growth of ventricular radiofrequency lesions created with a 4 mm ablation electrode was studied in 11 closed-chest dogs. Endocardial ablations were performed at 31 left and 15 right ventricular sites at a power setting of 25 Watts and 5, 10, 20, 30 or 60 seconds pulse duration. Macroscopic and histopathologic lesion examination were performed after one week survival. Mean lesion volume increased from 52 mm3 after 5 seconds pulse duration to a maximum 388 mm3 and approximately 7 mm depth after 30 seconds. Lesions were prolate spheroid in form, with a sparing of subendocardial myocardium and maximum lesion diameter at some millimeters depth. Results indicate that catheter positioning at no more than 7 mm from the target is required for successful ablation. Due to lesion geometry, subendocardial targets demand even more exact catheter positioning, while subepicardial substrates may not be ammenable to ablation if ventricular wall thickness exceeds 7 mm at the ablation site. Repeated pulses at adjacent sites may be required for ablation of extended arrhythmogenic areas. Volume at 5 seconds was only approximately 15% of mature lesions. Therefore, the use of a short 'test pulse' after careful mapping may be useful to pinpoint the most appropriate site for ablation in discrete pathways.

Animals↗
PubMed1992

Electrocardiogram of the humpback whale (Megaptera novaeangliae), with specific reference to atrioventricular transmission and ventricular excitation.

OBJECTIVES: The objective of the study was to record the electrocardiogram (ECG) of a large whale to obtain crucial data for comparative electrophysiologic analysis. BACKGROUND: The data were needed to establish the mismatch between heart size and PR interval and QRS duration in mammals. METHODS: In the waters off the coast of Newfoundland, in two humpback whales (Megaptera novaeangliae) with an estimated weight of 30,000 kg a 1-lead ECG was recorded, enabling reliable assessment of P waves and QRS complexes. RESULTS: It was found that both the PR interval (atrioventricular [AV] transmission time) and QRS duration (ventricular excitation) are extremely short for animals of this size. These findings are difficult, if not impossible, to explain on the basis of currently accepted electrophysiologic theories. However, the narrow QRS complex may be due to a very dense His-Purkinje network in the ventricular wall of whales. Alternative mechanisms that can explain the function of the mammalian AV node need to be considered and explored. CONCLUSIONS: The results of the study may be of value for the understanding of the ECG in humans.

Animals↗
PubMed1989

Control of radiofrequency lesion size by power regulation.

The influence of power and exposure duration on lesion size in radiofrequency catheter ablation was investigated in 15 closed-chest dogs. Radiofrequency energy was delivered to the right ventricular endocardium between the tip of a standard 6F electrode catheter and a large W and durations of 5, 10, 20, 30, and 60 seconds. At necropsy 1 week later, well-demarcated homogeneous lesions were found when power had exceeded a threshold level that decreased from 1.8 W at 5 seconds to 0.7 W at 60 seconds. Lesion size ranged from 0 to 7.5 mm in depth and 0 to 9 mm in diameter. For the 5, 10, and 20 second ablations, lesion size was determined by exposure duration and power level. However, after a 20 second exposure, lesion size had reached maturity and was related to delivered power only. Therefore, a gradual, controlled growth of the lesion can be obtained by a stepwise increase of the radiofrequency power level with ample exposure duration at each level to allow for stabilization. At levels exceeding 7 W, the formation of a thin insulating layer of blood coagulum on the electrode surface caused an abrupt increase of impedance within approximately 30 seconds. Therefore, lesion size is limited to 8.5 mm in radiofrequency ablation with a standard 6F endocardial electrode catheter.

Animals↗
PubMed1988

Effect of right ventricular pacing on ventricular rhythm during atrial fibrillation.

In 13 patients with atrial fibrillation, the effect of right ventricular pacing at various rates on spontaneous RR intervals was studied. Five hundred consecutive RR intervals were recorded and measured before and during varying right ventricular pacing rates. As anticipated, all RR intervals longer than the right ventricular pacing intervals were abolished. However, RR intervals shorter than the right ventricular pacing intervals were also eliminated. It is difficult to explain the elimination of RR intervals shorter than the pacing intervals with the accepted concepts concerning the mechanisms governing the rate and rhythm of the ventricular response to atrial fibrillation. An alternative explanation may be that during atrial fibrillation the atrioventricular node behaves as a nonprotected pacemaker that is electrotonically modulated by the chaotic atrial electrical activity. The result is a random ventricular rhythm. With right ventricular pacing, the automatic focus is depolarized by the retrogradely concealed conducted ventricular impulses, the short RR intervals are not generated as a consequence and the rhythm becomes pacemaker dependent.

Aged↗
PubMed1988

Morphology of endocardial T-waves of fusion beats.

Recently developed stimulation techniques are capable of eliminating polarization afterpotentials caused by the emitted stimulus. A well-controlled study method was developed to initiate various degrees of fusion and to monitor changes in the morphology of the endocardial signal. The study was performed on two dogs. The zone during which fusion could be provoked was less than 30 ms in both dogs. In addition, the results show a significant decrease in the endocardial T-wave amplitude as soon as fusion was noticed, while the QT interval then slightly lengthened. Furthermore, the evoked R-wave duration shortened during fusion, while the stimulus to R-wave interval lengthened. These results have consequences for pacemakers that use evoked endocardial signal characteristics for driving a pacemaker function.

Animals↗
PubMed1986

Reliability of evoked endocardial T-wave sensing in 1,500 pacemaker patients.

Intracardiac measurements of the evoked endocardial T-wave were performed on 1,500 pacemaker patients. The sensed evoked T-wave amplitude was found to be above 0.75 mV in 94.1 percent of all cases. No correlation was found between the amplitude of the spontaneous R-wave and that of the evoked T-wave. Some electrode characteristics proved to be more favorable than others for evoked endocardial wave sensing, i.e., a surface area of less than 12 mm2, porous surface structure (preferably carbon), and atraumatic fixation.

Electrocardiography↗
PubMed1986

Rate stabilization by right ventricular pacing in patients with atrial fibrillation.

A recent study of de Jongste has demonstrated the lengthening of short R-R intervals in patients with atrial fibrillation by right ventricular pacing. We have further analyzed the data from this study and specifically looked at the effect of right ventricular pacing on the R-R interval instability and heart rate. At the cost of only a slight increase in mean heart rate, a major reduction of the R-R interval instability can be obtained by right ventricular pacing. Based on these findings, we have developed and evaluated an automatic pacing rate algorithm, which continuously varies the stimulation rate in order to stabilize the otherwise irregular rhythm in patients with atrial fibrillation.

Atrial Fibrillation↗
PubMed1984

The importance of software programmable pacemakers: in vivo programming of a prototype device.

Recently, we have developed microcomputer-oriented pacemakers with true software flexibility. The first 25 devices implanted (DPG-1 type) exhibited an unexpected phenomenon caused by a microcomputer error. A safety mechanism switched off all special functions and automatically reset all parameters to standard settings. The problem was solved by noninvasive modification of the software. More than 200 units (TX-1 type), which are rate responsive pacemakers based on the QT principal, were implanted up to May 1984. These pacemakers were built using the same microelectronics as used in the DPG 1 pacemaker. Knowledge gained from clinical evaluation was directly applied not only to the patients receiving new implants but also to the preexisting implantees. This was done by software reprogramming in the implanted unit.

Arrhythmias, Cardiac↗