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Biomedical subjects

H Kulbertus

Publications and source records attributed to H Kulbertus.

At least 145 records · Page 8Linked to original sources
PubMed1985

Programmable extrastimulus pacing for long-term management of supraventricular and ventricular tachycardias: clinical experience in 16 patients.

Sixteen patients with recurrent, drug-resistant supraventricular (13 patients) or ventricular (3 patients) tachycardia were treated chronically by programmable extrastimulus pacing; either a fully automatic device (Telectronics PASAR 4151: eight patients with supraventricular tachycardia) or a patient--activated device (Medtronic Interactive Tachy System) was used. During a follow-up period of 5 to 30 months, five of the subjects treated with the fully automatic device showed successful results, one had recurrent tachycardia, and two had their units explanted for system-related problems. The patients treated with the externally activated device were, on the whole, very well controlled. This mode of treatment, if applied in well-selected cases, is promising; it seems safe and considerably reduces the number of hospital admissions.

Adult↗
PubMed1985

Evaluation of the effects of molsidomine by cardiac equilibrium blood pool scintigraphy.

We have used equilibrium gated blood pool scintigraphy to evaluate the hemodynamic effects and duration of action of molsidomine, a new peripheral vasodilator antianginal drug, after sublingual administration (4 mg) in five patients with heart failure. The following parameters were studied at rest and 10, 60, and 240 minutes after drug administration: left and right ventricular ejection fractions, end-diastolic and end-systolic volumes, stroke volume, heart rate, and cardiac index. Systolic and diastolic blood pressures were determined by cuff measurement. Statistically significant (p less than 0.05) changes were observed after 10 minutes for left ventricular ejection fraction (+26.2%), left and right end-diastolic volume (-12.4% and -15.2%), left ventricular end-systolic volume (-15%), and cardiac index (+7.9%); after 60 minutes for left ventricular ejection fraction (+49%), left ventricular systolic volume (+30.5%), cardiac index (+29.7%), systolic blood pressure (-7.9%), and right ventricular end-diastolic volume (-14.3%); and after 240 minutes for cardiac index (+23.9%), systolic blood pressure (-6.3%), and right ventricular ejection fraction (+23.1%). No changes in heart rate were observed. No patient experienced any side effect. We conclude that the hemodynamic improvement observed with molsidomine can be prolonged and results both from preload and afterload reduction.

Adult↗
PubMed1985

Prevention by acebutolol of rhythm disorders following coronary bypass surgery.

Seventy-one patients submitted routinely to coronary artery bypass surgery were randomized into 2 groups. Group A (32 patients) received 24 hr after initiation of surgery an intravenous perfusion of 100 mg of acebutolol given over 24 hr (22 cases) or 600 mg administered orally (10 cases). On subsequent days, they received 1200 mg of acebutolol/day orally. Group B (39 patients) was used as control. The groups were comparable in terms of age, sex, severity of coronary disease, preoperative therapy, duration of extracorporeal circulation, aortic clamping time, and immediate postoperative haemodynamic findings. No patient received digitalis. During hospital stay (10 days), 1 group A patient (3%) and 13 group B patients (33%; P less than 0.001) developed a sustained episode of atrial arrhythmia (fibrillation, flutter or atrial ectopic tachycardia). The majority of these rhythm disorders developed between days 2 and 4. On Holter monitoring on days 7-10, malignant ventricular extrasystoles (grades IV and V of Lown's classification) were more frequent in group B (65.2%) than in group A (19.3%; P less than 0.001). Haemodynamic measurements taken at rest performed in 27 patients on days 7-10 (16 patients of group A; 11 of group B). No difference was observed between the two groups. Acebutolol is a safe and efficacious drug for the prevention of arrhythmias following coronary surgery.

Acebutolol↗
PubMed1985

Electrophysiologic effects, antiarrhythmic activity and pharmacokinetics of cibenzoline studied with programmed stimulation of the heart in patients with supraventricular reentrant tachycardias.

Cibenzoline, an imidazoline derivative is a new antiarrhythmic agent. Its electrophysiological effects and antiarrhythmic properties were studied with programmed electrical stimulation of the heart in 12 patients with recurrent episodes of reentrant supraventricular tachycardia; atrionodal (5 cases), circus movement tachycardia involving an accessory pathway (6 cases), intraatrial reentry (one case). Cibenzoline was infused intravenously at a dose of 1 mg kg-1 to 1.75 mg kg-1 during sustained episodes of tachycardia and over 9 to 15 min. Cibenzoline shortened the sinus cycle length, moderately increased the transnodal conduction time and markedly lengthened the HV interval. The refractory periods of the atrioventricular (A-V) node, the atrium and the ventricle did not change. The effects of cibenzoline on accessory pathways used in the anterograde direction were measurable in 4 cases. Complete blockade of the bypass was seen in every case. In the retrograde direction the refractory period of the bypass could be evaluated; in 5 patients it lengthened systematically. Infused intravenously during epidoses of tachycardia, the drug terminated the rhythm disorder in 9 out of 12 cases. Tachycardia could still be initiated in 8 patients after i.v. cibenzoline (2 out of 5 A-V nodal tachycardias, 6 out of 6 circus movement tachycardias). The distribution of the drug followed a bicompartment pharmacokinetic model. The plasma levels at the end of infusion ranged from 1.34 to 3.19 microgram ml-1. Cibenzoline, primarily has class I antiarrhythmic properties and its well-understood pharmacokinetics should be of help in tailoring the treatment to the individual needs of the patient.

Adolescent↗
PubMed1984

[How and why treat supraventricular tachycardias].

The present study deals with pathophysiological and clinical aspects of two major supraventricular tachyarrhythmias: atrial fibrillation and reciprocating tachycardia. The main hemodynamic effects and the most frequent complications are examined, and therapeutic indications are given concerning pharmacologic, surgical or electrical treatment. Twelve patients with supraventricular tachycardia (5 with intranodal reentry and 7 with A-V by-pass tract) were treated with Propafenone and evaluated by repeated electrophysiological testing. Acute infusion of Propafenone (2 mg/kg over 10 minutes) interrupted the induced tachycardia in 9 of 11 patients (81%); Propafenone prevented the induction of the arrhythmia in 60% of patients with nodal reentry and in none with A-V by-pass. Electrophysiological evaluation repeated after one week of oral treatment (300 mg three times daily) in 5 patients indicated complete protection in two patients; in three the arrhythmia was still inducible but had a significantly lower rate. Finally, with regard to electrical treatment, data are presented concerning 10 patients with supraventricular reentrant tachycardia (4 intranodal, 6 with A-V by-pass tract) in whom an antiarrhythmic pacemaker was implanted (5 type Pasar Telectronics, 5 type Medtronic SP 500). The results were highly favourable in 9 patients with complete control of the arrhythmia.

Anti-Arrhythmia Agents↗
PubMed1983

Natural evolution of atrioventricular conduction in patients with sick sinus syndrome treated by atrial demand pacing. A study of 26 cases.

The authors have followed up 26 patients with sinus node disease who were treated by atrial pacing. The follow-up duration varies between 10 months and 3 years. Assessment of A.V. conduction was performed repeatedly by atrial pacing at increasing rates. Nine patients showed a progressive, sometimes early, deterioration of their A.V. conduction system; five (19%) developed second degree A.V. block of Mobitz type I for pacing rates lower than 100 beats/min. In three of them, the pace-maker had to be replaced by a dual chamber stimulator. Deterioration of A.V. conduction seems to be more frequent in subjects with antecedents of myocardial infarction (4/5) than in others (5/21: p less than 0.05). Deterioration of A.V. conduction is not uncommon among patients with sinus node dysfunction, especially after myocardial infarction. This constitutes a serious limitation to the use of atrial pacing.

Adult↗
PubMed1982

Hemodynamic response to glyceryl trinitrate in a spray at rest and during exercise in a sitting position.

Glyceryl trinitrate (GNT, 0.8 mg) was administered in a spray to 15 coronary patients of whom 7 had a pulmonary wedge pressure (PWP) greater than 16 mm Hg on exercise (subgroup I) and the others (subgroup II) had a normal PWP at rest and during exercise. At rest, GNT increased heart rate and decreased cardiac output, systolic index, stroke work index, right atrial pressure, pulmonary wedge and mean systemic pressures in all patients. Peripheral resistances did not change. During exercise, GNT lowered PWP, systemic arterial pressure and peripheral resistances in all cases. It increased cardiac output as well as systolic and stroke work indices only in patients of subgroup I. In subjects with coronary disease, no overt cardiac failure but elevated PWP on exercise, GNT in a spray can quickly improve exercise capacity and hemodynamic reserves and increase anginal threshold.

Administration, Oral↗