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G Steinbeck

Publications and source records attributed to G Steinbeck.

At least 73 records · Page 4Linked to original sources
PubMed1998

[Significance of electron-beam tomography in the evaluation of the patency of aortocoronary bypasses].

PURPOSE: Electron beam tomography (EBT) permits acquisition of images with high spatial and temporal resolution. The value of EBT and other imaging modalities for the depiction of patent coronary artery bypass grafts (ACVB, IMA) are compared to coronary angiography and an overview of current results is given. MATERIAL AND METHODS: Graft patency can be evaluated with indirect methods stress, such as echocardiography, radionuclide ventriculography, myocardial scintigraphy, positron-emission tomography (PET) and direct imaging modalities, such as Doppler/2D echocardiography, EBT, spiral computed tomography (SCT) and magnetic resonance angiography (MRA). RESULTS: With indirect methods graft patency can be evaluated with sensitivity of 64-100% and specificity of 73-100%. EBT and SCT are equivalent in sensitivity (= 94%) in the assessment of open venous grafts and specificity is up to 100%, but EBT is superior in the diagnosis of patent IMA grafts (sensitivity 100% vs 89%). Visualization of high-grade venous bypass stenosis seems possible with EBT. MRA with gradient echo technique is highly accurate in the assessment of patent venous grafts (sensitivity 77-93%) but has limited value in the evaluation of IMAs (sensitivity = 53%). Promising are ultrafast 3D-MRA methods which permit high accuracy (sensitivity = 94-96%) in assessing venous and arterial grafts. DISCUSSION: Indirect imaging methods cannot differentiate between an occluded bypass, progression of coronary artery disease and myocardial infarction. EBT and SCT are equivalent in the diagnosis of open and occluded venous grafts, but EBT is superior in the assessment of patent IMA grafts. Visualization of high-grade venous bypass stenosis seems possible with EBT. MRA techniques, especially ultrafast 3D-MR methods, are highly accurate in the assessment of patent venous and arterial grafts but are still limited to scientific research.

Coronary Artery Bypass↗
PubMed1998

[Functional imaging of the heart with electron-beam computed tomography].

PURPOSE: Electron-beam computed tomography (EBCT) enables examinations with a very short acquisition time of 50 ms and thus permits cardiac imaging without motion artifacts. Utilizing eight detector rings simultaneous image acquisition in up to eight levels and complete imaging of the whole heart is possible. In studies, functional imaging with EBCT was compared to our angiocardiography, echocardiography, radionuclide, ventriculography and magnetic resonance tomography. MATERIALS AND METHODS: ECG-triggered long- and short-axis cine studies were performed with the Imatron C-150 Evolution, acquiring 160 and 156 images at 8 and 12 levels. After manual tracing of epicardial and endocardial borders, ventricular size, ejection fraction, wall-thickening and myocardial mass were calculated. RESULTS: A very high correlation between EBCT and direct determination of right and left ventricle (r = 0.98 and r = 0.99) was demonstrated. Compared to echocardiography, angiocardiography and radionuclide ventriculography, assessment of ventricular function was more precise and more reliable. DISCUSSION: EBCT allows the exact and reliable determination of left and right ventricular function. Also precise assessment of myocardial mass is possible. However, the high radiation exposure and diagnostic effort have to be considered.

Angiocardiography↗
PubMed1998

[Electro-anatomic mapping of the sinoatrial activation: initial experiences with the new CARTO mapping system].

Prerequisite for successful radiofrequency catheter ablation on tachycardias is the exact mapping during the electrophysiologic study. The new mapping system CARTO allows a three-dimensional color-coded electroanatomic map of impulse propagation using electromagnetic technology. Mapping of sinuatrial activation in the right atrium of 11 patients represents the first clinical experience with this new system. The physiological activation sequence could be determined in all patients three-dimensionally, and the sinus node could be localized as a physiological activation focus with interindividual variability only in the sagital plane without complications. The nonfluoroscopic mapping system allows high resolution visualization of electrical activity and may therefore improve precision and simplify the determination of the arrhythmogenic substrate during tachycardias for successful catheter ablation.

Adult↗
PubMed1998

[Repetitive monomorphic ventricular tachycardia (Gallavardin type): clinical and electrophysiological characteristics in 20 patients].

Repetitive monomorphic ventricular tachycardia (RMVT) is defined by the presence of numerous monomorphic isolated, premature ventricular complexes, couplets, and runs of unsustained ventricular tachycardia having the same morphology in patients without structural heart disease. Patients with RMVT mostly demonstrate the typical left bundle branch block morphology with normal or rightward axis during tachycardia. At our institution, 20 patients with RMVT have been systematically studied: a syncope had occurred in 35% of our patients, in three cases a syncope was the first manifestation of the RMVT. Of our RMVT patients, 25% developed sustained episodes (> 3 min) of ventricular tachycardia as documented by Holter ECG. The salvos of ventricular tachycardia are generally short in RMVT. This behavior and the typical exercise dependence differentiates RMVT from paroxysmal sustained idiopathic ventricular tachycardia. Exercise testing is mandatory for correct diagnosis of RMVT. In our institution, 85-90% of RMVT patients demonstrated runs of ventricular tachycardia or sustained ventricular tachycardia while on a treadmill (exercise test) or during isoproterenol infusion. RMVT was inducible by programmed electrical right ventricular stimulation in only 13% of our patients. Therefore, in patients with suspected RMVT programmed electrophysiological stimulation is only useful to differentiate a ventricular tachycardia from a supraventricular tachycardia with bundle brunch block or in patients with unexplained syncope. The prognosis is considered generally good; in our patients no life threatening ventricular tachyarrhythmias were observed during a follow-up of up to 4 years. Verapamil and beta-adrenoceptor antagonists generally offer symptomatic improvement. In some cases treatment with a class III antiarrhythmic agent is necessary. While drug-refractory paroxysmal sustained idiopathic ventricular tachycardia can be abladed with both immediate and long-term success, catheter ablation of RMVT is only rarely indicated.

Adult↗
PubMed1998

[Analysis of functional changes in ventricular late potentials for risk assessment of ventricular tachycardias after myocardial infarct].

BACKGROUND: Electrophysiological abnormalities during ischaemia and increased heart rate may influence the detection of ventricular late potentials in the surface electrocardiogram. Whether the analysis of functional changes adds information to the risk stratification of patients prone to ventricular tachycardia is unclear. METHODS: We therefore retrospectively investigated 100 selected patients (25 with documented, sustained ventricular tachycardia (< 230/min) ( = VT group), 25 resuscitated from ventricular fibrillation (VF group) and 50 without ventricular arrhythmias (phi VT/VF group)) in the chronic phase after myocardial infarction. Late potential analysis was performed at rest, during atrial pacing at a rate of 100/min and 120/min (n = 60), during and after occlusion of the coronary artery for coronary angioplasty (PTCA) (n = 70), and immediately after maximum exercise using selective signal averaging. RESULTS: At rest in 72% of patients in the VT group, in 32% of the VF group, and in 6% of the phi VT/VF group late potentials could be found. During atrial pacing in 80% of patients in the VT group, in 72% of the VF group, and in 10% of the patients in the phi VT/VF group and during ischaemia because of occluded coronary artery in 86% of patients in and the VT group, 70% of the VF group, and in 20% of the patients of the phi VT/VF group late potentials were present. Immediately after maximum exercise which let both ischaemia and increased heart rate, late potentials were detectable in 92% of patients in the VT group, 80% of the VF group, and in 14% of patients in the phi VT/VF group. Similar results could be achieved by using the Holter-ECG after exact correction of recorder tape speed variations. 62% of patients with only by ischaemia, increased heart rate or exercise provokable late potentials and all patients with preexistent not by PTCA extinguished late potentials developed recurrent ventricular tachycardias during the one year follow-up period. Patients without late potentials (n = 50) and patients with preexistent by PTCA extinguished late potentials (n = 11) had no recurrent ventricular tachycardias. Cycle length of recurrent and clinical tachycardia in patients with preexistent not by PTCA extinguished late potentials (n = 18) were significantly longer than in patients with only provokable late potentials (n = 21). CONCLUSIONS: Analysis of functional changes of ventricular late potentials with exercise or in Holter ECG recordings promises considerable improvement of postinfarction risk stratification especially in patients prone to ventricular fibrillation.

Adult↗
PubMed1998

T wave spectral variance: A new method to determine inhomogeneous repolarization by T wave beat-to-beat variability in patients prone to ventricular arrhythmias.

Inhomogeneous repolarization is considered to be associated with increased risk of ventricular arrhythmias, but exact determination of the end of the T wave is difficult, and a single measurement of the QTc interval may be insufficient for risk stratification. A new algorithm was therefore developed to determine the beat-to-beat variability of the T wave in Holter electrocardiographic recordings. This algorithm, termed T Wave Spectral Variance (TWSV) uses the two-dimensional fast Fourier transform to determine the beat-to-beat variability of the T wave in Hotter ECG recordings. The two-dimensional fast Fourier transform was calculated by use of a data matrix with 1,024 consecutive single beats (first dimension) and a 200-ms segment centered on the T wave (second dimension). The power spectra of the 2D-FFT revealed the frequency content of the T wave in the first dimension and the periodicity of these frequencies in cycles per beat in the second dimension. A TWSV index of periodicity was calculated by dividing total spectral energy by spectral energy at 0 cycles per beat. A TWSV index of 0 means a constant T wave from beat to beat; a TWSV index of 1 means a completely irregular T wave. Of the 200 patients investigated, all of whom had had myocardial infarctions, 50 had documented sustained ventricular tachycardia (VT) (<230 beats/min) (group 1), 50 had ventricular fibrillation (VF) (group 2), and 100 were without VT or VF (group 3); 10 normal subjects were also investigated. The visually determined QTc was 442 +/- 62 ms in group 1, 402 +/- 13 ms in group 2, 411 +/- 26 ms in group 3, and 398 +/- 43 ms in normal subjects (differences not significant). The TWSV index was 0.95 +/- 0.14 in group 1, 0.90 +/- 0.16 in group 2, and 0.64 +/- 0.24 in group 3; it showed a highly constant T wave in normal subjects (0.52 +/- 0.23). Differences between patients with VT and VF as against patients without VT or VF were significant (P < .05), whereas no statistical differences between patients with VT and VF could be found. Thus, TWSV, a new method to assess beat-to-beat variability of the T wave, revealed increased heterogeneity of repolarization in patients prone to both VT and VF after myocardial infarction, whereas a single QTc interval measurement showed no significant differences.

Algorithms↗
PubMed1998

Selective suction and pressure-regulated retroinfusion: an effective and safe approach to retrograde protection against myocardial ischemia in patients undergoing normal and high risk percutaneous transluminal coronary angioplasty.

OBJECTIVES: We sought to study the safety, feasibility and efficacy of selective suction and pressure-regulated retroinfusion to protect against myocardial ischemia in patients undergoing normal risk and high risk balloon angioplasty. BACKGROUND: In a pig model of acute myocardial ischemia it was previously shown that use of selective suction and pressure-regulated retroinfusion was able to substantially preserve regional myocardial function during ischemia with a higher efficacy than that obtained with unselective synchronized retroperfusion. METHODS: In 42 patients with normal risk (n = 27) or high risk (n = 15) percutaneous transluminal coronary angioplasty (PTCA), alternate balloon inflations of the left anterior descending coronary artery (60 s) were either supported or not supported by selective suction and pressure-regulated retroinfusion of the anterior interventricular vein. In an additional group of 10 patients with normal risk, retroinfusion was directly compared with autoperfusion during 10 min of ischemia. RESULTS: Balloon inflations without retroinfusion resulted in a decrease of regional myocardial function in the ischemic zone to 13% of baseline. In contrast, regional myocardial function was preserved at 76% of baseline (p < 0.05) during balloon inflation supported by retroinfusion. This preservation of regional myocardial function by retroinfusion was maintained during 10 min of ischemia with at least similar efficacy compared with autoperfusion. With retroinfusion, hemodynamic variables were stabilized in normal risk and high risk patients. No complications related to the catheterization of the anterior interventricular vein using a femoral approach (95% success rate) were observed, and clinical follow-up after 3 to 6 months was uneventful with regard to the coronary intervention. CONCLUSIONS: Use of selective suction and pressure-regulated retroinfusion was feasible and safe and had a high efficacy for preserving regional myocardial function and hemodynamic variables during PTCA in normal risk and selected high risk patients.

Aged↗
PubMed1998

Single-beat analysis of ventricular late potentials in the surface electrocardiogram using the spectrotemporal pattern recognition algorithm in patients with coronary artery disease.

AIMS: Post-infarction risk stratification can be ascertained from beat-to-beat variations in ventricular late potentials. However, gaining such information by conventional late potential analysis using signal averaging is still not possible. METHODS: We therefore developed the spectrotemporal pattern recognition algorithm in order to detect beat-to-beat variations in late potentials. Based on the spectrotemporal pattern recognition algorithm two-dimensional correlation function, the typical spectral pattern of late potentials can be identified in spectrotemporal maps of single beats, even in the presence of noise. RESULTS: Surface electrocardiograms of 385 patients after myocardial infarction (85 with documented sustained ventricular tachycardia (group 1), 100 with fast, polymorphic ventricular tachycardia (> 270 cycles.min-1) or primary ventricular fibrillation (group 2), 200 without ventricular arrhythmias (group 3) and 45 healthy volunteers (group 4), were analysed. The spectrotemporal pattern recognition algorithm detected late potentials in single beats in 89% of group 1 patients, in 79% of group 2, in 22% of group 3 and in 4% of normals. The spectrotemporal pattern recognition algorithm measured late potential frequency and extension of late potentials into the ST segment, which was significantly different between groups 1 and 2. Beat-to-beat variations in late potentials, with respect to frequency and extension into the ST segment, were markedly higher in patients with a history of primary ventricular fibrillation. CONCLUSION: Single-beat analysis using the spectrotemporal pattern recognition algorithm may improve risk stratification of patients after myocardial infarction, and provides information on patients prone to ventricular fibrillation.

Action Potentials↗
PubMed1998

Fast pathway ablation in patients with common atrioventricular nodal reentrant tachycardia and prolonged PR interval during sinus rhythm.

AIMS: This study aimed to clarify the safety and efficacy of selective fast pathway ablation in patients with atrioventricular nodal reentrant tachycardia and a prolonged PR interval during sinus rhythm. Such patients have been reported to have an increased incidence of complete atrioventricular block. METHODS AND RESULTS: In this study, the earliest retrograde atrial activation during atrioventricular nodal reentrant tachycardia and right ventricular stimulation was localized. Fast pathway ablation was then performed in five patients with the common form of atrioventricular nodal reentrant tachycardia and a prolonged PR interval. Three of the five patients had almost incessant atrioventricular nodal reentrant tachycardia. Radiofrequency catheter ablation induced a complete ventriculo-atrial block during right ventricular stimulation in four patients and a marked prolongation of ventriculo-atrial conduction during right ventricular stimulation in one. Non-inducibility of common atrioventricular nodal reentrant tachycardia with and without isoproterenol was achieved in all five patients. The PR interval increased from 254 +/- 53 ms to 276 +/- 48 ms and the atrio-His interval from 172 +/- 46 ms to 192 +/- 45 ms. Second- or third-degree atrioventricular block did not occur during the ablation procedure. During the followup of 19 +/- 20 months none of the patients developed symptoms suggestive of atrioventricular nodal reentrant tachycardia or evidence of second- or third-degree atrioventricular block. CONCLUSION: These data suggest that atrioventricular node (retrograde) fast pathway ablation can apparently be safely performed in patients with common atrioventricular nodal reentrant tachycardia and a prolonged PR interval during sinus rhythm.

Adult↗
PubMed1998

Experience with pectoral versus abdominal implantation of a small defibrillator. A multicenter comparison in 778 patients. European Jewel Investigators.

AIMS: The aim of the study was to examine the results of implanting small sized cardioverter defibrillators in the pectoral as opposed to the abdominal area. Hitherto. owing to the large size of the early defibrillators, the site of implantation had been confined to the abdomen. METHODS: Between 30 March 1993 and 1 November 1994, 778 patients from 63 centres in 14 countries underwent their first device implantation. The study was set up to evaluate the safety and the efficacy of Medtronic models 7219 D, a multi-lead abdominal/pectoral implantable cardioverter defibrillator, and 7219 C, a pectoral single-lead Active Can implantable cardioverter defibrillator. There were 155 abdominal and 623 pectoral implants. Survival data were comparable during a mean follow-up period of 4.0 +/- 4.6 months, with no difference regarding the pectoral placement of single (n = 392) or multi-lead (n = 231) devices. The only significant difference was related to severe lead-related events: 5.3% in the pectoral vs 11.6% the abdominal group (P < 0.05). These events were mainly related to lead dislodgement. Kaplan-Meier estimates showed that both single and multi-lead systems, in either the pectoral or abdominal position, demonstrated a similar severe adverse event-free survival. CONCLUSION: These findings suggest that an implantable cardioverter defibrillator (18 mm thick, 80 cc volume, 129 g weight) can be implanted in the pectoral position without an increase in clinically relevant adverse events compared to abdominal implantation. Pectoral implantation was associated with significantly reduced lead-related severe adverse event rate.

Abdominal Muscles↗
PubMed1998

Superiority of ibutilide (a new class III agent) over DL-sotalol in converting atrial flutter and atrial fibrillation. The Ibutilide/Sotalol Comparator Study Group.

OBJECTIVE: To compare the efficacy and safety of a single dose of ibutilide, a new class III antiarrhythmic drug, with that of DL-sotalol in terminating chronic atrial fibrillation or flutter in haemodynamically stable patients. DESIGN: Double blind, randomised study. SETTING: 43 European hospitals. PATIENTS: 308 patients (mean age 60 years, 70% men, 48% with heart disease) with sustained atrial fibrillation (n = 251) or atrial flutter (n = 57) (duration three hours to 45 days) were randomised to three groups to receive a 10 minute infusion of 1 mg ibutilide (n = 99), 2 mg ibutilide (n = 106), or 1.5 mg/kg DL-sotalol (n = 103). Infusion was discontinued at termination of the arrhythmia. MAIN OUTCOME MEASURE: Successful conversion of atrial fibrillation or flutter, defined as termination of arrhythmia within one hour of treatment. RESULTS: Both drugs were more effective against atrial flutter than against atrial fibrillation. Ibutilide was superior to DL-sotalol for treating atrial flutter (70% and 56% v 19%), while the high dose of ibutilide was more effective for treating atrial fibrillation than DL-sotalol (44% v 11%) and the lower dose of ibutilide (44% v 20%, p < 0.01). The mean (SD) time to arrhythmia termination was 13 (7) minutes with 2 mg ibutilide, 19 (15) minutes with 1 mg ibutilide, and 25 (17) minutes with DL-sotalol. In all patients, the duration of arrhythmia before treatment was a predictor of arrhythmia termination, although this was less obvious in the group that received 2 mg ibutilide. This dose converted almost 48% of atrial fibrillation that was present for more than 30 days. Concomitant use of digitalis or nifedipine and prolongation of the QTc interval were not predictive of arrhythmia termination. Bradycardia (6.5%) and hypotension (3.7%) were more common side effects with DL-sotalol. Of 211 patients given ibutilide, two (0.9%) who received the higher dose developed polymorphic ventricular tachycardia, one of whom required direct current cardioversion. CONCLUSION: Ibutilide (given in 1 or 2 mg doses over 10 minutes) is highly effective for rapidly terminating persistent atrial fibrillation or atrial flutter. This new class III drug, under monitored conditions, is a potential alternative to currently available cardioversion options.

Adult↗
PubMed1998

'True' atrial tachycardia.

Atrial tachycardia is a rare form of supraventricular tachycardia, accounting for about 10-15% of patients presenting to experienced arrhythmia centres for radiofrequency catheter ablation. The mechanism may be either focal due to increased or abnormal automaticity or triggered activity, or macro re-entrant. When incessant tachycardia is present, tachycardiomyopathy may develop. The efficacy of antiarrhythmic drugs for long-term management of atrial tachycardia is poorly defined, but is probably limited. Class IC or class I agents may be used in re-entrant atrial tachycardia, and verapamil, beta-blockers or class IC agents in the focal type. If these drugs fail, amiodarone may be tried. Experience with radiofrequency catheter ablation to cure atrial tachycardia is limited, but results are very promising with success rates between 80% and 95%, and an acceptably low recurrence and complication rate. Thus, it is likely that, with more experience, radiofrequency catheter ablation will become therapy of first choice for atrial tachycardia when this arrhythmia is not easily and effectively controlled by drugs.

Anti-Arrhythmia Agents↗
PubMed1998

Effects of Class I drugs on atrial fibrillation.

This article reviews our knowledge about the efficacy of Class I antiarrhythmic agents, especially quinidine, propafenone, and flecainide, for pharmacologic conversion of atrial fibrillation to sinus rhythm. When given intravenously or orally for the long term, conversion rates between 50% and 90% are reported for restoration of sinus rhythm as well as for maintenance of sinus rhythm after DC cardioversion. Based on transtelephonic monitoring of arrhythmia recurrences as well as tolerance, Class IC agents appear to be especially effective for suppressing clinical symptoms in patients with paroxysmal atrial fibrillation. For patients who develop atrial fibrillation following coronary artery surgery, Class I agents are the second choice of treatment only. The concept of single oral loading with Class IC agents for conversion of atrial fibrillation appears attractive, but more data are needed before we conclude that it is efficacious as well as safe when given to ambulatory patients. Because all Class I antiarrhythmic agents have the potential for lethal proarrhythmia, the greatest and as yet unsettled issue is safety. Until the advent of large-scale and long-term trials demonstrating the efficacy and safety of Class I agents for the treatment of patients with atrial fibrillation, this strategy, although very popular to suppress frequent and unpleasant symptoms due to atrial fibrillation, cannot be regarded as firmly established.

Anti-Arrhythmia Agents↗
PubMed1997

Aggressive lowering of fibrinogen and cholesterol in the prevention of graft vessel disease after heart transplantation.

BACKGROUND: A combined treatment of statins and extracorporeal H.E.L.P.-apheresis (Heparin-mediated Extracorporeal LDL/fibrinogen Precipitation) has already been shown to be beneficial for coronary artery disease (CAD). Presumably high levels of LDL cholesterol, Lp(a), and fibrinogen also increase the risk for graft vessel disease (GVD). Therefore, we studied whether this concept can be applied in GVD, based on the hypothesis that GVD is an accelerated form of CAD. METHODS AND RESULTS: For comparison of statin treatment alone with the combined treatment, two matched groups of 10 cardiac transplant recipients were studied during a mean period of 3.6+/-1.0 years. Both groups were comparable in clinical characteristics, immunosuppressive medication, baseline plasma Lp(a), and high fibrinogen levels. Group I had normal LDL-C levels (3.36+/-0.60 mmol/L). Simvastatin alone was administered in this group to counteract the LDL-increasing effect of the immunosuppressive medication. Group II had marked hypercholesterolemia (LDL-C, 6.07+/-1.89 mmol/L), which was treated, in addition to simvastatin, with H.E.L.P.-apheresis weekly. GVD was assessed by coronary angiography. Simvastatin alone kept LDL-C levels within baseline limits but could not prevent GVD in 7 of 10 patients. In contrast, the combined treatment prevented GVD in 9 of 10 patients (P=.006) by simultaneous and drastic reduction of 48% LDL-C (P=.006), 35% fibrinogen (P=.002), and 47% Lp(a) (P=.006) below baseline. Both treatments were well tolerated and did not affect prevention of graft rejection and infections. CONCLUSIONS: A strategy of early, drastic lowering of fibrinogen, LDL-C, and Lp(a) helps to prevent GVD.

Adult↗
PubMed1997

Simvastatin reduces graft vessel disease and mortality after heart transplantation: a four-year randomized trial.

BACKGROUND: Accelerated graft vessel disease (GVD) represents the most serious long-term complication of heart transplantation. A possible cause underlying this progressive coronary vascular disease is believed to be post-transplantation hypercholesterolemia. METHODS AND RESULTS: In a 4-year prospective randomized study with heart transplant recipients, the efficacy of primary antihypercholesterolemic therapy with simvastatin was compared with that of general dietary therapy. The aim of the treatment was to maintain post-transplantation LDL-cholesterol levels at <120 mg/dL. Seventy-two heart transplant recipients receiving standard triple immunosuppression were randomly assigned to an active-treatment group (low-cholesterol diet and simvastatin, n=35) or a control group (general dietary measures, n=37). In the course of 4 years after transplantation, the simvastatin group had significantly lower LDL-cholesterol concentrations than the control group (mean+/-SD, 115+/-14 versus 156+/-17 mg/dL,P=.002), a significantly better long-term survival (88.6% versus 70.3%,P=.05), and a lower incidence of GVD in the coronary angiographic findings (16.6% versus 42.3%,P=.045). The incidence of graft rejections did not differ between the two groups, although there was a tendency toward a lower number of serious rejections in the simvastatin group (2.8% versus 13.5%, P=.1). Intracoronary ultrasound performed after 4 years in a subgroup of 27 patients (simvastatin, 10; control, 17) showed less intimal thickening in patients with LDL-cholesterol levels of <110 mg/dL (170+/-84 versus 370+/-171 microm, P=.04) and a lower intimal index (13.8+/-7.1% versus 27.9+/-12.1%,P=.04). CONCLUSIONS: In comparison with dietary measures alone, the combination of a low-cholesterol diet and simvastatin after heart transplantation led to a significant reduction in cholesterol levels, a significantly higher long-term survival rate, and a lower incidence of GVD.

Adult↗
PubMed1997

[Genesis, pathophysiology and clinical aspects of cardiac arrhythmias. Characterization of the risk patient].

Extrasystoles and both supraventricular and ventricular tachycardias may occur as a complication of almost any underlying cardiac disease and many extracardiac causes; on the other hand, also a patient without any detectable structural heart disease may present with these arrhythmias. Refined mapping techniques of the intracardiac conduction process have let to important new informations about the pathophysiology of sustained tachycardias (focal impulse formation, macro-reentry) with practical consequences, for example when ablation of these arrhythmias by radiofrequency catheter ablation is considered. Cardiac arrhythmias may lead to both typical and atypical symptoms. Finally, the patient at risk of sudden cardiac death is characterized. One needs to differentiate patients who have survived a life-threatening event of ventricular tachycardia or have been successfully resuscitated from cardiac arrest (both situations usually need life-long antiarrhythmic interventions for secondary prophylaxis) from patients who also are at high risk, however, are asymptomatic until now. For the latter population, symptoms due to extrasystoles or assessment of the severity of ventricular ectopic beats by the Lown classification are of minor importance; most emphasis in this regard, however, must be placed on the type and severity of underlying cardiac disease.

Cardiac Complexes, Premature↗