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Biomedical subjects

J Goldberger

Publications and source records attributed to J Goldberger.

14 recordsLinked to original sources
PubMed1992

Stimulation of the summit of the right ventricular aspect of the ventricular septum during orthodromic atrioventricular reentrant tachycardia.

Application of ventricular premature complexes (VPCs) from the right ventricular (RV) apex during orthodromic atrioventricular (AV) reentrant tachycardia has limitations both in the ability to shorten the succeeding atrial cycle length and in helping to identify accessory pathway location. Stimulation from the summit of the RV aspect of the septum during AV reentrant tachycardia was investigated as a new technique to improve the diagnostic utility of applying VPCs during AV reentrant tachycardia. VPCs were induced during AV reentrant tachycardia at 10 ms decrements in patients with left free wall (n = 15), posteroseptal (n = 5), and right free wall (n = 3) accessory pathways from the RV apex and then from the summit of the RV septum. When the His was refractory, shortening of the atrial cycle length was noted in 13% of patients with left free wall pathways, in 60% of patients with posteroseptal pathways, and in 100% of patients with right free wall pathways with VPCs from the RV apex, and in 47, 100 and 100%, respectively, with VPCs from the summit of the septum. When all VPCs were considered, there was a significant shortening of the atrial cycle length in 67% of patients with left free wall pathways when stimulated from the RV apex, which increased to 93% with summit stimulation. An extrastimulus applied on or after the His effected a significant shortening of the atrial cycle length in no patients with left free wall pathways.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1992

Efficacy and risks of moricizine in inducible sustained ventricular tachycardia.

OBJECTIVE: To assess the efficacy and toxicity of moricizine in treating patients with serious ventricular arrhythmias and inducible sustained ventricular tachycardia. DESIGN: Uncontrolled clinical trial. SETTING: The intensive care and telemetry units of Northwestern Memorial Hospital, St. Francis Hospital and Medical Center, and Lenox Hill Hospital. PATIENTS: Twenty-six patients with sustained ventricular arrhythmias or hemodynamically significant nonsustained ventricular tachycardia, most of whom failed therapy with at least one class I antiarrhythmic agent. INTERVENTION: Patients were treated with moricizine, 400 to 1000 mg/d. MEASUREMENT: Efficacy was assessed by the results of programmed ventricular stimulation done during moricizine therapy. MAIN RESULTS: Seven of the 26 patients (27%) developed life-threatening ventricular proarrhythmia during moricizine loading. Three patients had incessant sustained ventricular tachycardia, two had incessant nonsustained ventricular tachycardia, one had new sustained ventricular tachycardia, and one had new cardiac arrest. One of these patients died of intractable ventricular fibrillation. No clinical or electrophysiologic variables clearly identified those at risk for proarrhythmia. Only 3 of 26 patients (12%) became noninducible on moricizine. CONCLUSION: Moricizine has a low rate of efficacy and carries a considerable risk for life-threatening proarrhythmia in patients with serious ventricular arrhythmias and inducible ventricular tachycardia who have failed therapy with other class I antiarrhythmic agents.

Adult↗
PubMed1992

Physiology of "atypical" atrioventricular junctional reentrant tachycardia occurring following radiofrequency catheter modification of the atrioventricular node.

The physiology of atypical atrioventricular junctional reentrant tachycardia (AVJRT) occurring following catheter modification of the AV node is poorly defined. Six patients undergoing radiofrequency current catheter modification of the AV node had inducible atypical AVJRT before or after AV nodal modification. Typical AVJRT was differentiated from atypical AVJRT by a ventriculoatrial (VA) time < 60 msec in the His-bundle electrogram recording. Five of six patients had typical AVJRT and two had atypical AVJRT prior to AV nodal modification. Following anterior approach AV nodal modification, previously undetected atypical AVJRT was induced in four patients. Earliest retrograde atrial activation in the posterior septum was documented in all patients with atypical AVJRT prior to modification and in three of four patients with atypical AVJRT following modification. The AH intervals during tachycardia were 320 +/- 52 msec in typical AVJRT, 88 +/- 33 msec in the premodification atypical AVJRTs, and 172 +/- 12 msec in the postmodification atypical AVJRTs (P = 0.0001). The AH/HA ratios were 4.1 +/- 0.9 in typical AVJRT, 0.5 +/- 0.2 in the premodification atypical AVJRTs, and 0.9 +/- 0.2 in the postmodification atypical AVJRTs (P = 0.0001). Two patients with postmodification atypical AVJRT underwent further posterior approach AV node modification that resulted in VA block. One patient with postmodification atypical AVJRT had further anterior approach AV nodal modification that resulted in heart block. The retrograde limb of the atypical AVJRT seen following anterior approach AV nodal modification is a posterior, slow pathway.

Atrioventricular Node↗
PubMed1991

Ablation of the atrioventricular junction with radiofrequency energy using a new electrode catheter.

Percutaneous catheter ablation using radiofrequency energy can be used to interrupt atrioventricular (AV) conduction in patients with supraventricular tachycardia refractory to drugs. Results of radiofrequency ablation of the AV junction using a custom-designed catheter with a large, 3-mm-long distal electrode, 2-mm interelectrode spacing, and a shaft with increased torsional rigidity were compared with those using a standard quadripolar electrode catheter (Bard EP). An electrocoagulator (Microvasive Bicap 4005) supplied unmodulated radiofrequency current at 550 kHz, which was applied between the distal electrode of the ablation catheter and a large skin electrode. With use of the modified catheter, 12 of 13 patients (92%) had persistent complete AV block induced with 7 +/- 5 applications of 18 +/- 6 W of radiofrequency power. In contrast, complete AV block was produced in only 9 of 18 (50%) historical control patients treated with the standard catheter, despite a similar number of applications (7 +/- 5) and power output (16 +/- 4 W). A rise in impedance, due to desiccation of tissue and coagulum formation, occurred earlier (28 +/- 18 vs 52 +/- 24 seconds, p less than 0.001) and more frequently (54 vs 40% of applications, p = 0.047) in patients treated with the standard catheter than in patients treated with the modified catheter. The use of a catheter designed to increase the surface area of electrode-tissue contact allows more radiofrequency energy to be delivered before a rise in impedance occurs and appears to increase the effectiveness of radiofrequency ablation of the AV junction.

Atrioventricular Node↗
PubMed1991

Catheter modification of the atrioventricular junction with radiofrequency energy for control of atrioventricular nodal reentry tachycardia.

BACKGROUND: The utility of transcatheter application of radiofrequency energy to eliminate atrioventricular nodal reentrant tachycardia (AVNRT) was investigated. METHODS AND RESULTS: Thirty-nine patients (mean age, 53 +/- 20 years; range 14-86 years) with medically refractory AVNRT underwent perinodal ablation with radiofrequency energy. A custom-designed 6F catheter with a large (3-mm-long) distal electrode and interelectrode pacing of 2 mm was used in the majority of cases. The catheter used for ablation was initially positioned across the tricuspid anulus to obtain the largest His bundle electrogram, then withdrawn to obtain the largest atrial:ventricular electrogram ratio, with a small His bundle electrogram (less than or equal to 100 microV). Each application of radiofrequency energy (350-550 kHz, 16.2 +/- 5.2 W) was stopped after 60 seconds or if PR prolongation or an impedance rise was noted. The endpoints of the procedure were persistent modification of atrioventricular nodal conduction (either first-degree atrioventricular block or impairment of ventriculoatrial conduction) and noninducibility of AVNRT before and during isoproterenol administration. Radiofrequency energy was applied a mean of 6.8 +/- 3.5 times per session. After a mean follow-up of 8 +/- 3.0 months, 32 of the 39 patients (82%) have been free of AVNRT, and did not have high grade AV block. Three patients (8%) developed complete atrioventricular block and had pacemakers implanted. Two patients had unsuccessful initial procedures, and two patients had initially successful ablations but had recurrences of tachycardia 4-6 weeks later. Elimination of AVNRT appeared to be due to effects on the retrograde fast pathway in most patients. CONCLUSIONS: Radiofrequency ablation of the perinodal right atrium appears to be safe and effective for treatment of typical AVNRT:

Atrioventricular Node↗
PubMed1990

Lengthy or repeated hospitalization in infancy. Issues in stimulation and intervention.

Given that environmental stimulation is inevitable, the role of intentional stimulation programs for infants in hospitals should be to modify the environment to provide adequate and appropriate developmental opportunities. Given the discomforts that are inherent in hospitalization and illness, maximizing comfort is of primary importance. For infants who are particularly at risk, maximizing their motivation as active learners and their parents' sense of competence and control supersedes any other stimulation agenda. Reinforcing areas of health in the infant and the infant-family relationship should be a focus during the vulnerability of hospitalization.

Child, Hospitalized↗
PubMed1989

Clinical utility of nifedipine and diltiazem plasma levels in patients with angina pectoris receiving monotherapy and combination treatment.

The clinical utility of nifedipine and diltiazem blood levels in patients with angina pectoris receiving monotherapy (N = 14) and combination treatment (N = 9) were assessed in a placebo run-in, double blind, randomized, crossover study. Compared to placebo, diltiazem (mean daily dose 360 mg), nifedipine (mean daily dose 90 mg) and combination diltiazem-nifedipine therapy (mean daily dose 55 mg of nifedipine, 360 mg of diltiazem) were associated with reductions in weekly angina attacks and nitroglycerin consumption. Although both drugs used as monotherapy and in combination were also associated with significant increments in exercise tolerance and other improved angina parameters, these changes were not related to the plasma levels of either drug. Nifedipine plasma levels were measured by gas chromatography and diltiazem plasma levels measured by reverse high-pressure liquid chromatography from specimens obtained 2-5 hours after the last previous dose, after 1, 2 and 3 weeks of treatment, and during baseline placebo and placebo washout periods. With combination therapy, there was no effect on the diltiazem plasma level compared to monotherapy. The significant decrease in the nifedipine dose in patients on combination therapy did not significantly change nifedipine plasma levels. Determinations of plasma levels of diltiazem and nifedipine in the management of patients is of no value in the management of patients with angina pectoris except for monitoring treatment compliance and overdosage.

Aged↗
PubMed1988

Atrial infarction: diagnosis and management.

Atrial infarction has been a relatively understudied entity. Its incidence by autopsy study has been widely variable, from 0.7% to 42%, with the largest series of 182 patients demonstrating an incidence of 17%. The right atrium is involved five times as often as the left, with the auricle the predominant site in either atria. Clinical atrial infarction may present with supraventricular arrhythmias, atrial rupture, hemodynamic compromise from loss of atrial "kick," and thromboembolic phenomena. Diagnosis currently is made in an appropriate clinical setting with characteristic PR interval changes. Other noninvasive techniques have shown only limited diagnostic utility, but esophageal echocardiography may prove to be a useful technique in this setting.

Arrhythmias, Cardiac↗
PubMed1987

Enalapril, hydrochlorothiazide, and combination therapy in patients with moderate hypertension.

Using a placebo baseline, positive controlled, double-blind, randomized titration to effect our study protocol, we assessed the antihypertensive actions of enalapril, hydrochlorothiazide, and their combination in 37 patients with moderate essential hypertension. Patients were maintained on their regular diets and received a placebo for 4 weeks. Patients with moderate systemic hypertension were randomized to receive enalapril monotherapy at a dose of 10 mg twice daily (n = 16), hydrochlorothiazide monotherapy at a dose of 25 mg twice daily (n = 15), or combination therapy consisting of 10 mg enalapril and 25 mg hydrochlorothiazide twice daily (n = 6). Therapy could be titrated to twice the starting dose. All treatment regimens reduced blood pressure, but only one patient had blood pressure normalized (diastolic blood pressure less than or equal to 90 mmHg) with enalapril (7%), two patients with hydrochlorothiazide (15%), and 80% of patients with combination therapy. The patients who had not achieved normal blood pressure received combination treatment, and after 8 additional weeks, more than 70% showed normal blood pressure. After one year of combination therapy, 92% of the patients continue to have normal blood pressure. Both the monotherapy and combination regimens were very well tolerated in this study. In conclusion, enalapril, hydrochlorothiazide, and their combination are effective in reducing blood pressure in patients with moderate hypertension. However, monotherapy is successful in normalizing blood pressure only in a small percentage of patients. Combination therapy achieved normalization of blood pressure in almost all patients, suggesting that most patients on regular diets with moderate hypertension may require a diuretic-ACE inhibitor combination rather than monotherapy to achieve effective blood pressure control.

Adult↗
PubMed1986

Calcium-channel blockers for combined angina pectoris and systemic hypertension.

Calcium-channel blockers have been successfully used in the treatment of angina of effort and systemic hypertension. Many patients present with concomitant angina pectoris and hypertension. Controlled clinical trials demonstrate that the calcium-channel blockers are safe and effective as monotherapy in the treatment of these patients, and that their use compares favorably with that of propranolol. The effectiveness of these agents in hypertension appears to be primarily due to their ability to induce systemic vasodilation. Calcium-channel blockers have several therapeutic effects in angina pectoris. Beneficial actions on the major determinants of oxygen consumption, i.e. heart rate, blood pressure and contractility, are generally seen. The potent coronary vasodilating actions of these agents allow for increased coronary blood flow. Improvements in ventricular compliance, regression of left ventricular hypertrophy and cardioprotection appear to be additional effects of the calcium-channel blockers; their contribution to the drugs' overall therapeutic efficacy is presently being evaluated. Calcium-channel blockers are a welcome addition to drug regimens available for the management of patients with coexisting angina pectoris and hypertension.

Adult↗