Biomedical subjects

G S Wolff

Publications and source records attributed to G S Wolff.

At least 37 records · Page 2Linked to original sources

PubMed1986

Application of the Rosenblueth hypothesis to assess cycle length effects on the refractoriness of the atrioventricular node.

In adults, the effective refractory period of the atrioventricular (AV) node is lengthened, whereas that of the atrium, His-Purkinje system or ventricular myocardium is shortened with a shorter atrial pacing cycle length. However, in children, the effective refractory period of the AV node at shorter cycle lengths is also shortened. Based on Rosenblueth's 1-step delay hypothesis, an index of refractoriness within the AV node is defined as the longest coupling interval at the level of step delay within the AV node of an impulse that cannot be conducted to the His bundle. The slopes relating cycle length and refractoriness of the AV node are determined by both the conventional and revised methods in 9 pediatric patients with heart disease. The slope is positive for all patients using the revised method. The difference in values between the 2 methods in older children is striking because the slope is converted from a negative to a positive value. It is concluded that the AV node has the same positive slope relating cycle length and refractoriness as other cardiac tissues.

Adolescent↗

PubMed1985

Site of conduction delay and electrophysiologic significance of first-degree atrioventricular block in children with heart disease.

Associated electrophysiologic abnormalities and site of delay were studied in 20 patients, aged 1.5 to 16.5 years, with congenital heart disease and first-degree atrioventricular (AV) block (PR interval above the 98th percentile for age and heart rate). Eight of the 20 patients with first-degree AV block were studied after 1 or more cardiovascular operations. Refractory periods of the atrium, AV node, His-Purkinje system and ventricle were determined. As a further test for AV nodal integrity, rapid atrial pacing was performed and the cycle at which Wenckebach periodicity occurred was noted. Four groups were identified. Group I included 4 patients (20%) with intraatrial conduction delay (long PA interval). Three patients had depressed sinus nodal function and 1 had depressed AV nodal function. Group II included 7 patients (35%) with AV nodal delay (long AH interval). One patient had sinus nodal depression and 2 had AV nodal depression (prolonged AV nodal refractory period or Wenckebach at a long paced cycle length). Group III included 3 patients (15%) with His-Purkinje delay (long HV interval). Measured functions were normal in all patients. Group IV included 6 patients (30%) with normal or high normal intracardiac intervals with long PR. One patient had sinus nodal dysfunction, 2 patients had long atrial refractory periods, 1 had AV nodal depression; 2 had long refractory period of the His-Purkinje system, and 1 had long ventricular refractory period. Atrial flutter was induced in 1 patient.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

PubMed1985

Rapid atrial pacing-induced infra-His conduction block in children.

High right atrial pacing (abrupt initiation and random coupling to the spontaneous rhythm) was performed in 285 pediatric cardiac patients for diagnostic purposes. Nine patients (3%) were found to have pacing-induced infra-His conduction block. In two patients this occurred following a preceding long cycle as well as a preceding short-to-long sequence cycle length change. In five patients block occurred with an abrupt shortening of the coupling H-H interval (in three patients the infra-His block initiated a series of 2:1 infra-His block). In two patients with type II second-degree atrioventricular block the initiating events were not recorded. In one of them, when the rapid atrial pacing was incremented to the same cycle length with infra-His block, the atrioventricular response became 1:1 with normal conduction. These findings of pacing-induced infra-His conduction block can be explained by the normal response of the His-Purkinje system to changes in the preceding cycle lengths, and to the abrupt shortening of the coupling interval.

Cardiac Pacing, Artificial↗

PubMed1984

Cardiac rhythm after the Mustard operation for complete transposition of the great arteries.

The Mustard operation corrects the effects of congenital transposition of the great arteries by creating an intraarterial baffle to direct pulmonary venous blood to the tricuspid orifice and systemic venous blood to the mitral orifice. To identify the long-term effects of this procedure, we followed 372 patients with complete transposition of the great arteries who survived the Mustard operation for at least three months. The mean follow-up period was 4.5 years (range, 0.4 to 15.9); the mean age at operation was 2.0 years. Mean resting heart rates were consistently lower than those for age-matched normal children. Seventy-six per cent of the patients had sinus rhythm during the year of operation--a figure that decreased to 57 per cent by the end of the eighth postoperative year. Twenty-five patients died during the follow-up period, nine suddenly. Life-table analysis revealed a cumulative survival rate of 91 per cent for 11 years and 71 per cent for 15 years after the operation. No strong risk factor for sudden unexpected death identified. This study demonstrates that extended survival among patients with transposition can be expected after the Mustard operation. However, over time there is a decreasing prevalence of normal sinus rhythm in survivors, as well as a small risk of sudden death.

Actuarial Analysis↗

PubMed1984

M-mode echocardiographic findings in children with idiopathic restrictive cardiomyopathy.

The M-mode echocardiographic findings in five pediatric patients, ages 4-15 years, with primary idiopathic restrictive cardiomyopathy, diagnosed by cardiac catheterization, and of 12 normal children (control group) are presented. The M-mode echocardiographic findings in patients with restrictive cardiomyopathy were (1) normal left and right ventricular end-diastolic dimension, (2) normal left ventricular posterior wall and interventricular septal thickness (three patients) or mild concentric hypertrophy (two patients), (3) normal opening and closing velocity of the mitral valve, (4) consistently enlarged left atrium (more than 40 mm) in all, and (5) right ventricular systolic time intervals compatible with pulmonary artery hypertension. The left ventricular ejection phase parameters (systolic time intervals, shortening fraction, and mean velocity of circumferential fiber shortening) were normal. Left ventricular relaxation phase parameters (diastolic function) were abnormal. The isovolumic relaxation time index was prolonged, 68 +/- 40 ms (+/- SD), in the study group as compared with 11 +/- 6 ms (+/- SD) in the control group (P less than 0.001). Percent relaxation of left ventricular posterior wall endocardium at 50% of diastole was decreased, 58 +/- 4% (+/- SD), in the study group as compared with 85 +/- 6% (+/- SD) in the control group (P less than 0.005). We conclude that M-mode echocardiography provides a relatively useful and specific noninvasive method for the diagnosis of primary restrictive cardiomyopathy in pediatric patients.

Adolescent↗

PubMed1984

Induction of nonsustained atrial flutter by programmed atrial stimulation in children: incidence, mechanisms, and clinical implications.

Nonsustained atrial flutter was induced by programmed atrial extrastimulation in 6 (4%) of 137 children with preoperative congenital heart defects, who underwent electrophysiologic evaluation as part of cardiac catheterization. None of these patients had ECG or clinical evidence of arrhythmias. Atrial reentry was induced by programmed atrial extrastimulation in these six patients at coupling intervals slightly longer than the coupling interval at which flutter was induced. The flutter cycle length was similar to the atrial refractory periods. The duration ranged between 0.4 second and 60 seconds. The PA interval and the duration of the P wave were normal in all of the patients. Five of the six had normal PR intervals. It is concluded that nonsustained atrial flutter may be induced by programmed atrial extrastimulation in dysrhythmia-free children. The cycle length is determined by atrial refractoriness and, contrary to adults with clinical atrial flutter, prolonged PA and P wave duration are not predisposing factors.

Adolescent↗

PubMed1984

Anomalous origin of the left anterior descending coronary artery from the pulmonary artery.

Three children were identified as having anomalous origin of the left anterior descending coronary artery (LAD) from the pulmonary artery (PA). Two had had congestive heart failure in infancy with clinical diagnosis of endocardial fibroelastosis and all had abnormal ECGs. The correct diagnosis was delayed in each case, and two patients required selective coronary angiography. Surgery was accomplished in the three children although ECG abnormalities have persisted and one child has dyskinesis of the left ventricular apex. Because this diagnosis may be difficult to make when intercoronary anastomoses are inadequate to outline the left anterior descending coronary flow into the PA, patients with clinical findings suggestive of anomalous coronary artery may require selective coronary studies to exclude this anomaly.

Adolescent↗

PubMed1983

A method of maintaining thermal homeostasis during cardiac catheterization in newborns.

This device has been designed to maintain thermal homeostasis in newborns undergoing cardiac catheterization. It is easily constructed from materials available in any hospital, and it is safe and effective. It consists of a warming coil and a delivery unit made from Plexiglas which encloses the patient. In addition to maintaining a neutral thermal environment, it allows for the selection of any desired oxygen concentration by simply blending the gas mixture before warming and delivery. Since using this device we have had no problems or complications related to thermal stress during catheterization of the neonate.

Body Temperature Regulation↗

PubMed1983

Hemodynamics and intracardiac conduction after operative repair of tetralogy of Fallot.

Electrophysiologic studies were performed in 47 children aged 3 to 18 years, 15 of whom had cardiac arrhythmias 1 to 15 years after repair of tetralogy of Fallot. Six exhibited sinus or atrioventricular nodal dysfunction, 8 had ventricular extrasystoles, and 1 had supraventricular tachycardia. Hemodynamic and electrophysiologic data were obtained at postoperative catheterization. Although electrophysiologic responses were abnormal in a proportion of both the children with and those without arrhythmia, hemodynamic values were similar. Three of 6 children with impaired sinus impulse generation or atrioventricular nodal conduction had a prolonged A-H interval, and in 3 Wenckebach heart block developed at low pacing rates. Ventricular ectopic rhythm was not associated with any particular abnormality of basic intracardiac conduction intervals. Thus, arrhythmias and conduction abnormalities are not consistently related to residual right ventricular hypertension. Abnormalities in electrophysiologic function are common after repair of tetralogy of Fallot in patients with sinus rhythm and may have prognostic implications for these patients.

Adolescent↗

PubMed1983

Multiple atrioventricular nodal pathways--a new electrophysiological phenomenon in children.

Multiple atrioventricular (A-V) nodal pathways are described in five dysrhythmia-free children with congenital heart defects. The five were some (2.9%) of 175 children who underwent diagnostic cardiac catheterization and electrophysiological evaluation over a three year period. Supraventricular tachycardia was not induced during the electrophysiological evaluation. Medical follow-up is recommended since multiple A-V nodal pathways have been demonstrated in adults with A-V nodal reentrant tachycardia.

Adolescent↗

PubMed1983

Site of conduction delay in children with catheter-induced right bundle branch block.

Eight cases of catheter-induced right bundle branch block (RBBB) in children during electrophysiologic studies are presented. Recording of right ventricular apical activation time (V-RVA) before and during the conduction delay allowed localization of the block along the course of the right bundle branch system. In the majority of patients, a significant lengthening of V-RVA was observed, indicating that proximal right bundle branch block is the most commonly induced type of conduction delay. Block was transient in all patients and terminated several minutes to 24 hours after its induction.

Adolescent↗

PubMed1983

Use of amiodarone in the therapy of primary ventricular arrhythmias in children.

4 children, ages 11-14 years, were diagnosed as having primary ventricular arrhythmias (3 ventricular tachycardia, 1 multifocal premature ventricular contractions) without underlying heart disease. All 4 patients were treated initially with standard antiarrhythmic drugs (quinidine, propranolol, procainamide) and either did not respond (3 patients) or experienced drug toxicity (quinidine - 1 patient) necessitating withdrawal of antiarrhythmic therapy. Amiodarone, a new antiarrhythmic agent, was initiated in a single oral daily dose of 10 mg/kg/day. All patients have shown a significant clinical response to oral amiodarone with either complete suppression of ventricular tachycardia in 2 patients, near complete suppression in 1 and abolition of multifocal premature ventricular contractions in the fourth patients. 2 patients have had corneal microdeposits detected by slitlamp examination and are receiving methylcellulose eye drops; no other adverse reactions have been encountered during the follow-up of 6 months to 3 years.

Adolescent↗

PubMed1982

Right ventricular apical activation time in children. Reference standards for clinical use.

To differentiate proximal from peripheral right bundle-branch block, several investigators have used the right ventricular apical (RVA) activation time, but there is a lack of reference standards for infants and other children. Using intracardiac electrography, His bundle and RVA electrograms were recorded in 123 children before surgery for various types of congenital cardiac malformations. None had evidence of conduction defects on their surface ECG. The average RVA activation time was 15 +/- 7 msec (+/- SD) linearly increasing with age from infancy to adolescence. The values found in this large population may be useful as reference standards for right bundle-branch conduction times in other infants and children.

Adolescent↗

PubMed1982

Pulsed Doppler echocardiographic detection of coronary artery to right ventricle fistula.

The pulsed Doppler echocardiographic (PDE) findings in a case of coronary artery right ventricle fistula are described. The PDE examination revealed normal flow patterns within the right atrium, pulmonary artery, and left ventricle, thus excluding these structures as the distal site of the fistula. Sampling within the right ventricular inflow revealed a turbulent, continuous, systolic-diastolic flow pattern that suggested the right ventricle was the distal end of the fistula. Postoperatively, the PDE examination of the right ventricle reverted to a normal, nonturbulent, phasic flow pattern. We conclude that PDE may be a useful noninvasive method of defining the site of drainage in cases of coronary artery fistula.

Child, Preschool↗

PubMed1982

Sinus and atrioventricular nodal function: Preoperative and early postoperative assessment in children.

Ninety-three rapid atrial pacing studies were performed in 38 children to compare preoperative and early postoperative function of the sinus and atrioventricular (AV) nodes. The interval between the preoperative and postoperative studies was under 6 months in the majority of patients. Postoperative studies were performed within 48 hours of operation and between 4 and 8 days after operation. Sinus nodal function as measured by sinus nodal recovery time (SNRT) was an unreliable index in determining depression since the number who improved postoperatively (10/55) was nearly equal to the number that worsened (12/55). The majority who had abnormal function postoperatively demonstrated a junctional rather than sinus recovery focus. This finding appears a more definitive and more reproducible indicator of sinus node depression in the postoperative patient. Postoperative AV nodal function was decreased (as measured by the cycle length [CL] at which Wenckebach periodicity occurred) in 15 of 55 studies (27%) of the entire group. There was nearly an equal chance for improvement (24%) in function. This also applied to those patients who had sequential studies. Therefore, this method of assessment for AV nodal function was unreliable, or else the operation did not affect the node significantly. The latter is unlikely in view of late postoperative data. The greatest utility of this test was to determine the capability for AV conduction in certain patients with slow escape rhythms in the absence of surface P waves, and to differentiate complete heart block from AV dissociation when atrial activity was absent. Despite the variability of effects on the sinus and AV nodes in these patients, those who demonstrated depression had a significantly higher incidence of dysrhythmias (80% of patients with sinus nodal depression and 100% of patients with AV nodal depression).

Adolescent↗

PubMed1981

Determinants of ventricular refractory periods in children with congenital heart disease: effects of cycle length and age.

Ventricular effective refractory periods (ERP) and functional refractory periods (FRP) were determined by programmed ventricular extrastimulation in 53 pediatric patients with a spectrum of congenital heart disorders. Of these 63 children (ages 8 months to 18 years), 38 were preoperative, 17 had repair of their cardiac lesion via right ventriculotomy, and eight were postoperative without a ventriculotomy. We demonstrated that there was a linear relationship between the cycle length and ventricular refractory periods. The regression equations 73 + 0.29 x cycle length (msec) for the ventricular ERP (msec) and 80 + 0.30 x cycle length (msec) for ventricular FRP (msec) were found to define the determined properties of ventricular refractory periods (VRP) in children. These VRP characteristics were independent of age in children less than 13 years of age.

Action Potentials↗

PubMed1981

Left isomerism and complete atrioventricular block: a report of six cases.

Six children, aged 12 days to 13 years, with left isomerism and complete atrioventricular (A-V) block are presented. In all six patients the diagnosis of left isomerism was suggested by an interrupted inferior vena cava found during cardiac catheterization and angiocardiography; four patients had complex heart disease consisting of endocardial cushion defect, five had a common atrium, three had pulmonary stenosis, three had patient ductus arteriosus and two had dextrocardia. Further anatomic abnormalities included situs inversus of the viscera (four patients) as well as partial malrotation of the bowel. Of the six patients, four had congenital complete A-V block, whereas the remaining two had A-V conduction disturbances documented during early infancy that progressed to complete A-V block later in life. All six patients required pacemaker implantation and five of the six patients died. This report discusses the clinical presentation of complete AV block and left isomerism and reviews the literature.

Adolescent↗

PubMed1981

Age-related differences in the protein binding of quinidine.

The in vitro serum protein binding of quinidine was determined in 26 pediatric patients. Group I consisted of 6 cord blood samples obtained at the time of delivery, group II of 8 infants aged 8-18 months, and group III of 12 children over the age of 2 years. The percentage of free quinidine in group I was 39.2 +/- 10.8, group II 24.4 +/- 10.6 and group III 16.6 +/- 6.5, demonstrating a larger proportion of unbound quinidine in the newborn group and an increase in protein binding with age (p less than 0.0001). Therefore, the protein binding of quinidine is diminished in the neonate and young infant and may result in enhanced quinidine activity.

Aging↗