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Biomedical subjects

I C van Gelder

Publications and source records attributed to I C van Gelder.

25 records · Page 2Linked to original sources
PubMed1994

Benefits and risks of antiarrhythmic drug therapy after DC electrical cardioversion of atrial fibrillation or flutter.

Electrical cardioversion is the method of choice to restore sinus rhythm in patients with chronic atrial fibrillation. After cardioversion, long-term maintenance of sinus rhythm is troublesome since many patients relapse. In addition, haemodynamic complications associated with recurrence and hazards of prophylactic antiarrhythmic drug therapy are among the problems threatening these patients. Several new antiarrhythmics have become available but their safety remains to be established. Advantages of prophylactic antiarrhythmic treatment must be carefully weighed against the hazards. As a consequence, non-pharmacological modalities like serial electrical cardioversions (no drugs) and His bundle ablation may become important treatment modalities. The present report summarizes current antiarrhythmic strategies, focusing primarily on feasibility of prophylactic treatment and on early and late proarrhythmia.

Anti-Arrhythmia Agents↗
PubMed1990

Patency of arm vein grafts used in aorto-coronary bypass surgery.

Arm veins have been used in myocardial revascularisation procedures as a last resort bypass conduit because of their associated low patency. Nevertheless, leg veins and mammary arteries, which are the most commonly used, are sometimes not sufficient, leaving little choice as to the bypass conduit. To assess the properties of arm veins in bypass surgery, we compared a group of 28 patients that underwent an arm vein graft coronary bypass procedure with a matched group of patients in which leg veins were used. In 28 patients, 40 arm vein grafts with 77 distal anastomoses were used (mean 1.9 +/- 0.9; range 1-5). A cerebrovascular accident was the cause of the sole death (2%) during the study period. The mean follow-up was 4.6 years (Standard deviation, SD: 1.5 years). More antianginal medication was used in the arm vein group (P = 0.017). Additionally, the percentage of the expected maximal frequency during exercise testing was lower in the arm vein group as compared to the leg vein group. Digital subtraction angiography showed that the patency of the arm vein bypass grafts was 47% (70% confidence limits, CL: 32%-62%) while the patency of the leg vein grafts was 77% (CL: 64%-87%), which was statistically significant (P = 0.051). Comparison of these figures with the few published reports on arm veins used as coronary bypass grafts reveals similar results. We conclude that the arm vein as a coronary bypass graft is only to be used when mammary arteries and leg veins are not available.

Arm↗
PubMed1990

Flecainide: long-term effects in patients with sustained ventricular tachycardia or ventricular fibrillation.

Efficacy of flecainide was investigated in 50 patients with sustained ventricular tachycardia (n = 38) or ventricular fibrillation (n = 12) during a 4-week in-hospital and 1-year follow-up period. Furthermore, the predictive value of programmed electrical stimulation, Holter monitoring, and exercise testing on outcome of long-term treatment was studied. Etiology of the tachyarrhythmia was coronary artery disease in 37 patients and other etiologies in 13 patients. The success rate of flecainide after 1 year, based on intention to treat, was 54%. The success rate during the in-hospital phase was 84% (in six patients flecainide was discontinued because of tachyarrhythmia and in two because of side effects). Calculated after 4 weeks hospitalization, the success rate was 78% for patients with tachyarrhythmias based on coronary artery disease and 55% for patients with tachyarrhythmias based on other etiologies (11 patients showed recurrences and two patients severe side effects). Patients with tachyarrhythmias based on coronary artery disease showed a lower ejection fraction and earlier recurrence than patients with arrhythmias based on other etiologies. Proarrhythmic effects developed in six patients (12%). Electrophysiological evaluation was performed in 28 patients at baseline and after intravenous flecainide. Negative predictive value of the electrophysiological evaluation after intravenous flecainide for patients with inducible tachyarrhythmias at baseline (n = 21) was 40%. For Holter monitoring (n = 24) this value was 86%. Non-ischemia-related induction of tachycardia by exercise was present in two of 30 patients on flecainide; both patients showed recurrence of the tachycardia.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1988

Abnormal pharmacokinetics of flecainide in a "nonresponder".

Flecainide is well absorbed after oral administration. Following rapid infusion of flecainide, there is a short distribution phase. Plasma levels of flecainide are proportional to dose. Both QRS durations and flutter wave intervals are lengthened after flecainide administration. We report an abnormal pharmacokinetic response to oral as well as intravenous flecainide in a patient who was treated with flecainide for several episodes of atrial flutter. In contrast to the usual pattern, this patient did not show a significant increase in QRS duration, flutter wave interval, or plasma concentration. We could not explain this abnormal pharmacokinetic response, but excluded a rapid and complete renal clearance, an excessively high rate of metabolization, and an abnormal binding mechanism as possible mechanisms. We concluded that flecainide may produce abnormal pharmacokinetic mechanisms, preventing appearance of unbound substance in plasma, thereby preventing occurrence of electrophysiological effects.

Administration, Oral↗
PubMed1988

Acute conversion of atrial fibrillation to sinus rhythm: clinical efficacy of flecainide acetate. Comparison of two regimens.

The efficacy and safety of oral (up to 400 mg in 3 h) and intravenous regimens (up to 150 mg in 10 min) of flecainide acetate were compared in the acute conversion of atrial fibrillation to sinus rhythm. Acute conversion was defined as conversion occurring within 5 h (oral) or within 30 min (intravenous regimen). Following classification in recent onset (duration less than 24 h) atrial fibrillation (n = 27) and chronic (greater than 24 h) atrial fibrillation (n = 13), patients were randomly assigned to one of the two regimens. In the group of patients with recent onset atrial fibrillation, 10 out of 14 (oral treatment) and 10 out of 13 (intravenous treatment) responded acutely. Approximately half of responding patients converted after the first oral dose or within the infusion time. In contrast, no patient with chronic atrial fibrillation showed conversion on flecainide. No serious adverse effects were encountered with the regimens used, not even in patients concomitantly using digitalis or verapamil. Thus, patients with recent onset atrial fibrillation can safely be converted to sinus rhythm using oral or intravenous regimens of flecainide.

Administration, Oral↗