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Biomedical subjects

H Volkmann

Publications and source records attributed to H Volkmann.

At least 55 records · Page 3Linked to original sources
PubMed1987

[Effect of body position on the ability to initiate paroxysmal supraventricular reentry tachycardias and on the conduction system properties of the reentry circuit].

The obtainability as well as the maintenance and termination of paroxysmal supraventricular reentry tachycardias depend upon the interaction of the individual components of the reentry circle, in which cases the properties of the pathway are influenced by the changing preponderance of the sympathetic and parasympathetic tonus and thus also by the body position. In 29 investigations by means of highly frequent and programmed transoesophageal atrial stimulation the influence of the body position on the initiation possibility of the paroxysmal supraventricular tachycardia and on the pathway properties of the individual components of the reentry circle are analysed. The investigations were performed either in the standing position or in lying position, in 16 patients for the objectivation of anamnestically reported paroxysms of tachycardia and in 13 patients for the therapy control after medicamentous stabilisation. In 6 patients supraventricular reentry tachycardias could be initiated only in standing position, in lying position only a few echo systoles appeared. In 9 patients in whom we obtained a tachycardia both in standing position and in lying position in upright posture an in most cases clear increase of the frequency of tachycardia was found. The evocation mode of the tachycardia was partly alleviated in the standing position, but also rendered difficult in several cases. It seems to be indicated to repeat the investigation under orthostatic conditions, when an adequate anamnesis of the tachycardia is present and an initiation possibility in lying position is lacking, or when a great subjective impairment in a paroxysm of tachycardia is reported and there is a relatively low frequency of tachycardia in lying position.

Adult↗
PubMed1987

[Electrical therapeutic procedures in recurrent, drug refractory tachycardias. II. Electrical transvenous catheter ablation].

In 6 patients with medicamentously therapy-refractory tachycardias (3 times auricular flutter/auricular fibrillation with very rapid atrioventricular conduction, once focal atrial tachycardia, once paroxysmal atrioventricular reentry tachycardia, once recurrent ventricular tachycardia on the basis of an interventricular reentry) percutaneous transvenous catheter ablations of the atrioventricular conduction region (bundle of His ablation, 5 cases) and the right Tawara branch (1 case), respectively, were performed. During a follow-up period of 2-26 months (on an average 10.5 +/- 8.0 months) a permanent total block in 4 cases could be obtained (3 times AV-block III. once complete right bundle branch block). In two other patients the total AV block receded to the AV block I. and II. respectively, within 2 and 8 days, respectively; in the first case the AV node reentry tachycardias were no more to be evoked, in the second case a tolerable ventricular frequency was the result during the auricular flutter recidivations. In all patients treated by means of catheter ablation after the intervention an impressive improvement of the clinical symptomatology developed. Due to possible complication and the dependence upon the pacemaker of the patients concerned which is to be expected the indication to the ablation should be made only after the exhaustion of all medicamentous possibilities and taking into consideration other electric therapy methods.

Adult↗
PubMed1986

[Therapeutic electrical procedures in recurring, drug refractory tachycardias. I. Antitachycardiac implantable pacemaker systems].

In 9 Patients with medicamentously therapy-refractory tachycardias (twice paroxysmal AV-node-reentry tachycardia, four times paroxysmal orthrodromic reentry tachycardia in the WPW-syndrome, once paroxysmal atrial reentry tachycardia, twice recurrent ventricular tachycardia) after adequate electrophysiological testings antitachycardiac pacemakers able to activate the patients were implanted. In these cases the implantable tachyblocker TUR-RFP-01 was used in 4 cases for the highly frequent volley atrial stimulation, in 2 cases for the more highly frequent volley ventricular stimulation. In 3 patients the interruption of the tachycardia was performed by ventricular underdrive stimulation by means of putting the magnet on a conventional R-wave-inhibited ventricular pacemaker. In all cases the recurrent tachycardias could reliably be terminated by the patients themselves by activation of the antitachycardiac systems (duration of the follow-up period 3-14 months, on an average 10.7 +/- 3.4 months); only in one case in the further course a change of the stimulation parameters was necessary which were carefully tested at the beginning. On account of the danger of the acceleration of the tachycardia and of the evocation of ventricular fibrillation, respectively, should, however, be performed highly frequent ventricular stimulations for the termination of ventricular tachycardias only in readiness for defibrillation.

Aged↗
PubMed1986

[Successful treatment of ventricular tachycardia by transvenous electrical ablation of the right Tawara branch].

Recurrent episodes of ventricular tachycardia not responding to medical treatment occurred in a 56 year old man. Electrophysiological investigation showed ventricular tachycardia due to bundle branch reentry. Using a method similar to catheter ablation of the atrioventricular junction an ablation of the right bundle branch was performed by an electrical shock of 250 J. While before the ablation ventricular tachycardia occurred several times a day, and its induction by programmed ventricular stimulation was facilitated by the administration of antiarrhythmic drugs, no initiation of ventricular tachycardia was possible after ablation of the right bundle branch. Over a follow-up of 4 weeks the patient has not suffered from tachycardia and the artificial right bundle branch block persists.

Bundle of His↗
PubMed1985

Myocardial bioptic findings in correlation with TL-201 imaging and hemodynamic parameters in patients with latent cardiomyopathies suspected of having myocarditis.

Sixty-eight patients (24 males, 44 females, mean age 37.2 years) belonging to NYHA classes I and II were investigated. All patients had a nondilated ventricle as well as hemodynamic criteria of "latent cardiomyopathy." In 78% of the patients, a high susceptibility to infection, frequent angina, or possible myocarditis were found. In 75.5%, the mean pulmonary artery pressure was abnormal. T1-201 scintigraphy revealed perfusion defects in 78%. Dyskinesia or hypokinesia were found in 52%. The left ventricular ejection fraction was normal in 74%. On biopsy, pathologic findings were detected in 60.9% of patients with a high frequency of hypertrophy and fibrosis (50%). In two patients, lymphocytic infiltrates were found. Immunohistologically, deposits of complement, IgG, IgM, and gammaglobulin, mainly in the sarcolemma, could be identified in 19.1% of cases. The myocardium was normal in 39.1%; insufficient material was found in 5.9% of patients. Morphologic, scintigraphic, and hemodynamic findings could not be correlated but the combination of two pathologic parameters permitted diagnosis. Biopsy was the most effective diagnostic method in myocarditis.

Adolescent↗
PubMed1984

[Long-term results in the treatment of atrial tachycardial arrhythmias using temporary electric stimulation procedures].

In 12 of 23 patients with atrial flutter, who were cardioversed by means of electric stimulation techniques and underwent a regular after-examination, a sinus rhythm was still existing 24 months after regularization. When these long-term results which in comparison to the late results are more favourable after electroshock cardioversion are interpreted apart from the different selection of patients must be taken into consideration that the rate of immediate success of about 50% was distinctly lower than in the DC-shock cardioversion. It is to be supposed that a stimulation therapy only in those patients leads to regularization, the atrial vulnerability and recidivity of whom is less distinct, whereas in the other cases only the transgression into an atrial fibrillation is successful.

Atrial Flutter↗
PubMed1983

[Preliminary diagnosis of heart rhythm disorders using transesophageal electrostimulation].

The transoesophageal electrostimulation of the heart offers as a non-invasive method in the preliminary diagnostics of disturbances of the cardiac rhythm, in which cases it shall not substitute the intracardiac electrography, but supplement its diagnostic possibilities. Particularly by the demonstration of the disturbed sinus node function or by initiation of tachycardias by means of transoesophageal stimulation methods the little extensive non-invasive examination method may lead to directing findings in patients with unclear arrhythmias and/or unclarified syncopes.

Arrhythmias, Cardiac↗
PubMed1982

[The significance of air contamination for the taking of blood cultures in open systems].

The importance of the air contamination, when open blood culture systems were used, was emphasized by investigation series in 20 test persons. The proportion of contaminated cultures correlated with the opening time and the size of the opening area of the culture systems applied. The moist cleaning of the room performed before the taking of the blood culture and low numbers of patients in the rooms clearly improved the portion of contamination.

Air Microbiology↗
PubMed1982

[Sinus node function test--diagnostic value and methodologic limits].

By means of atrial stimulation methods for the establishment of the sinus node recovery time and for the indirect calculation of the so-called sinuatrial conduction time under certain methodical conditions disturbances of the sinus node automatism and of the sinuatrial conduction may be differentiated and moreover latent dysfunctions of the sinus node may be unmasked. Methodical problems in the recognition of the sinus node recovery time by higher-frequent atrial stimulation and the calculation of the sinuatrial conduction time by programmed atrial single or double manifold stimulation result above all on that account, since the various factors which determine the reaction of the sinus node in atrial stimulation are not to be surveyed in the individual case. Since there are no obligatory and reliable criteria for the judgment of the function of the sinus node a statement on sensitivity and specificity of the diagnostic stimulation methods is scarcely possible. With regard to a therapeutic decision aid a higher-frequent stimulation for the determination of the sinus node recovery time is of greater importance than the calculation of the sinuatrial conduction time. For the identification of a disturbed function of the sinus node the two parameters make a diagnostic contribution of approximately the same value.

Cardiac Pacing, Artificial↗
PubMed1981

[The transesophageal approach to the heart in electrotherapy of tachycardia. II. Transesophageal cardioversion by means of direct current shock].

Electric experiments of cardioversion by means of direct current shock using special oesophagus electrodes were performed in 153 cases of various tachycardiac disturbances of rhythm. Here we succeeded in the conversion to the sinus rhythm in 86% of the patients with auricular flutter, in 84% of the cases with auricular fibrillation, in 3 of 4 patients with auricular tachycardias, in 10 patients with AV-junctional tachycardias without exception and in 5 of the 6 cases of ventricular tachycardias. Thus, the rate of an immediate success approximately corresponds to the conventional extrathoracic position of the electrodes. Here the smaller expenditure of energy with the possibility of an electrocardioversion also without anaesthesia as well as the readiness to the immediate electrostimulation in the case of an asystolia after cardioversion represent the essential advantages of the transoesophageal way. Despite the smaller rate of success on account of the smaller possibilities of complication, however, primarily transoesophageal stimulation techniques should be used (with the exception in auricular fibrillation), in which cases the use special oesophagus as in their failure following cardioversions by means of direct current shock transoesophageally through the same non-invasive approach. Moreover, the analysis of the oesophageally derivable ECG-potentials may facilitate the differentiation of the preexisting tachycardia.

Adult↗
PubMed1981

[The transesophageal approach to the heart in electrotherapy of trachycardiac arrhythmias. I. Transesophageal electrostimulation procedure].

Transoesophageal electrostimulation techniques were used in 124 cases of different tachycardiac disturbances of rhythm. By means of highly frequent transoesophageal atrial stimulation we succeeded in transformating into sinus rhythm in 46% of the patients with atrial flutter, in 29% of the cases with atrial tachycardias and in 75% of the patients with av-junctional tachycardias. At least atrial fibrillation (with decrease of the ventricular frequency) could be induced in 48% in pre-existing auricular flutter, in 38% in auricular tachycardias and in 15% in av-junctional atrial (partial success of therapy). Sinus tachycardias, atrial fibrillation and ventricular tachycardias could practically not be influenced by highly frequent transoesophageal atrial stimulation. Moreover, for the first time the techniques of the doubled or coupled atrial stimulation, in 2 cases also ventricular stimulations with higher frequency were tested on transoesophageal way and were introduced into the treatment of tachycardiac disturbances of rhythm. The therapeutic results of transoesophageal electrostimulation techniques seem to be comparable entirely with those of intracardiac stimulations, in which cases the non-invasive and uncomplicated techniques are accessible also to institutions without possibilities of heart catheterization.

Adult↗
PubMed1981

[Comparison of different stimulation procedures of the calculation of so-called sinoatrial conduction time].

The results of the premature individual atrial stimulation for calculating the so-called sinuatrial conduction times (SACT) were compared with those in double-manifold atrial stimulation (n = 160), frequent atrial stimulation (n = 50) and ventricular individual and double-manifold stimulation (n = 14), respectively. Premature atrial individual stimulation and atrial double-manifold stimulation in these cases gave corresponding, closely correlating results for the SACT-calculation. In frequent atrial stimulation were calculated considerably longer as well as (more infrequently) clearly shorter conduction times. Calculation errors are on the one hand thinkable due to lacking, on the other hand due to repeated sinus node depolarisation with the possibility of overdrive suppression and overdrive excitation (sinus node depression and sinus node acceleration) since the method does not allow a control of the sinus node depolarisation performed. Also in modified calculation of the SACT with consideration of the duration of spontaneous periods after stimulation the correlation to the results of the individual stimulation was relatively loose. After ventricular stimulation (and following ventriculo-atrial stimulus conduction) essentially shorter sinuatrial conduction times could be calculated than in the atrial place of stimulation. As a rule, the poststimulatory spontaneous interval showed an abbreviation compared with the duration of periods before the stimulation, in which cases the haemodynamic relations changed due to ventricular stimulation might explain the increase of frequency.

Cardiac Pacing, Artificial↗
PubMed1981

[Diagnostic transesophageal atrial stimulation as a sinus node function test. I. Normal values and comparison with right atrial stimulation].

For the non-invasive functional analysis of the sinus node diagnostic transoesophageal atrial stimulations were performed. By means of transoesophageal premature individual stimulation we succeeded in a calculation of the so-called sinuatrial conduction time in 112 of 118 normal persons (ESACT = 103 +/- 23.5 ms). In comparison to the results in right-atrial stimulation the transoesophageally established times were 20 to 30 ms longer. By means of transoesophageal atrial stimulation with higher frequency in 64 healthy test persons the recreation time of the sinus node was determined in 64 healthy test persons (ESNRT = 968 +/- 218 ms). Taking into consideration the double standard deviation in an upper limit of 1,400 ms was the result which corresponds to the limit in intraatrial stimulation. In the direct comparison of the transoesophageal and right-atrial stimulation technique in patients with and without syndrome of the sinus node for the sinuatrial conduction time (r = 0.81, n = 51) as well as for the recreation time of the sinus node (r = 0.90, n = 36) relatively good correspondences were found. In the transoesophageal stimulation, however, the larger distance of the place of stimulation from the marginal area of the sinus node, the conduction of the impulse over the left to the right atrium as well as a possible vagal irritation are to be taken into consideration.

Adult↗
PubMed1981

[Diagnostic transesophageal atrial stimulation for sinus node function testing. II. Results in patients with and without sinus node syndrome].

By means of transoesophageal atrial stimulation of higher frequency in patients with sinus node syndromes (n = 78) in about 60% of the cases a prolonged sinus node recovery time could be proved. After the end of the stimulation secondary stops appeared in about half of the patients, so that in 81% of the cases at least one pathological result was established. By means of premature individual transoesophageal stimulation (n = 99) in 2/3 of the patients with sinus node syndrome we contrived to perform a calculation of the sinuatrial conduction time. Half of all calculable values were above the normal. In 1/3 of the examined persons pathological stimulation patterns were found. Altogether 90% of the patients showed at least one pathological result, when apart from prolonged sinus node recovery times and sinuatrial conduction times at the same time secondary stops after serial stimulation with higher frequency and abnormal behaviour patterns of the post-extrasystolic stops after individual stimulation were taken into consideration. In patients with different cardiovascular diseases without clinical or electrocardiographic reference to a sinus node dysfunction in 25% of the cases at least one pathological result was found, in which case cannot be clarified, whether latent functional sinus node disturbances or falsely positive results are in question or not. Altogether the non-invasive transoesophageal stimulation technique leads to on principle diagnostic evidences of the same value as the up to now usual stimulation of the right atrium. Methodical problems which arise from the stimulation of the righ atrium in transoesophageal approach are to be taken into consideration in the interpretation of the results.

Adult↗
PubMed1980

[Non-invasive cardio-circulatory diagnosis with the help of retinal dye clearance].

Using the fluorescence microscopy the times of retinal passage A 1, V 1, A 2 and V 2 were determined in 36 patients with heart diseases. They were compared with different haemodynamic parameters, in 27 patients with intracardially got circulatory indicators. The time of the renal circulation (V 1-A 1) in certain respect correlastes with the time volume of the heart, the bolus-extension time (A 2-A 1) with the degree of insufficiency of the heart. The value V 2 appears as a very sensitive, unspecific measuring value, which is also influenced by the peripheral haemodynamic situation. The method seems to be suitable as non-invasive method. Its advantages consist in the small temporary, personal and material expenditure.

Coronary Circulation↗
PubMed1980

[Sinostrial node initial block after digoxin--unmasking by double and multiple stimulation].

After intravenous application of 1 mg digoxin in a 28-year-old patient with condition after myocarditis by means of premature atrial individual stimulation a SA-block I. type II was observed. Also in extremely premature stimuli the post-extrasystolic pauses remained compensating. After atrial double and multiple stimulation--a new method for the calculation of the sinuatrial conduction time--totally irregular poststimulation pauses appeared, which were regarded as an expression of a sinoauricular node initial block. Other possibilities of explanation are discussed.

Adult↗