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Biomedical subjects

K Steinbach

Publications and source records attributed to K Steinbach.

At least 37 records · Page 2Linked to original sources
PubMed1996

[Epidemiology of heart wall rupture in myocardial infarct].

In a retrospective study including 1888 consecutive patients (pts) with acute myocardial infarction (AMI) admitted in the years 1989-1993 to the CCU, the relationship between sex, age, history of angina, location of infarction and heart wall rupture has been studied in a multivariate regression model. Female sex (p = 0.0013), older age (p = 0.0001), first angina during the AMI (p = 0.001) were indicative for significantly higher risk of rupture. Women are at higher risk only with anterior wall AMI (p = 0.0393). This risk increases continually with age, more in pts with inferior wall AMI than anterior wall AMI (p = 0.339). Females over the age of 75 with anterior wall AMI and first AP, and males and females over 83 with inferior wall AMI and first AP are at the highest risk of rupture (48.6% of deaths). We conclude that the defined high risk pts should be carefully monitored concerning the signs of impending heart wall rupture.

Aged↗
PubMed1995

Cardioverter discharges following sensing of electrical artifact due to fluid penetration in the connector port.

We report a unique case of fluid penetration, 3 months after implantation, in the connector port of an automatic implantable cardioverter defibrillator (ICD) with transvenous subcutaneous lead system. The patient had coronary artery disease and recurrent episodes of ventricular fibrillation, the fluid caused electrical signals interpreted as ventricular fibrillation by the device, which triggered shock delivery.

Aged↗
PubMed1995

[Location of atrial and ventricular insertions of accessory atrioventricular pathways using surface ECG mapping and its importance in catheter ablation therapy].

BACKGROUND: The modern non-pharmacological therapy of the WPW syndrome by means of catheter ablation is based on the interruption of the accessory pathway(-s) by radiofrequency current energy. Destruction of the morphologic substrate of the arrhythmia alters the activation wave spread in the heart. OBJECTIVES: It was the aim of this report to demonstrate the diagnostic potential of BSM in localizing both overt and concealed accessory pathways. Presented study analyzes the alterations of the cardioelectric field by means of body surface ECG mapping in two female patients with accessory pathways before and after their successful curative treatment by radiofrequency catheter ablation. METHODS: Five patients were analyzed prior and after RF catheter ablation by BSM, two of them were selected for this presentation. One patient with WPW syndrome suffered from frequent supraventricular tachycardia due to in one female patient with an overt accessory pathway. The other patient was for several years incessantly in permanent junctional reentry tachycardia due to a concealed accessory pathway. The examination comprised 12-lead ECG, orthogonal vectorcardiogram according to Frank, BSM using a regular 80-electrode-array system and signal-averaged ECG. RESULTS: The RF ablation was successful in both patients and their arrhythmia was abolished. By means of a detailed analysis of the ventricular activation prior RF ablation in the patient with WPW syndrome the precise site of the ventricular insertion of the accessory pathway in the left lateral free wall was predicted. Furthermore, alterations of the terminal QRS complex were observed when comparing pre- versus post-ablation maps. In the second patient the atrial insertion of the accessory pathway with retrograde and decremental conduction was successfully localized to the right septal region by means of pre-ablation BSM. CONCLUSIONS: Both ventricular and atrial activation can be in detail analyzed by means of BSM. Such analysis offers more precise information on the spatial component of the activation wave spread. This case report gives further evidence that BSM is a useful method for precise localization of both ventricular and atrial insertion sites of accessory pathways in patients with paroxysmal tachycardias due to this electrophysiologic abnormality. This information gained recently clinical impact since it can be directly used for faster arrhythmogenic substrate targeting during ablation therapy. (Fig. 5, Ref. 17.)

Adolescent↗
PubMed1995

[Efficacy of the implantable cardioverter-defibrillator in patients on the waiting list for heart transplantation].

8 of 122 patients receiving an implantable cardioverter defibrillator (ICD) in our department since 1985 for the treatment of ventricular tachyarrhythmias were considered candidates for cardiac transplantation. In 6 of 8 patients, at least one successful ICD discharge (range 1-378 discharges) was documented in the follow up time until transplantation. These therapies included cardioversions/defibrillations as well as overdrive stimulation in sustained monomorphic ventricular tachycardia. 1 patient died shortly before receiving a compatible organ. The remaining 7 patients survived successful heart transplantation undertaken 7-34 months after implantation of the cardioverter defibrillator. Cardiac transplantation was not complicated in any of these patients by the previous ICD management. Our results show the high efficacy of ICD as "bridge to transplant" therapy unit cardiac transplantation.

Adult↗
PubMed1995

[The value of tilt-table examination in diagnosis of syncope: studies of 24 patients].

Sudden hypotension, alone or combined with bradycardia is a major cause of syncope. 24 consecutive patients with a history of > 1 syncope of unknown aetiology were exposed to vagal provocation by the head-up tilt test. The clinical symptoms were reproduced in 11 patients under the given protocol, representing a sensitivity of 46%. The patients were followed up for 13.2 +/- 5.3 months. 7 of the 11 patients (64%) with a positive result on tilting versus 2 of the 13 patients (15%) with a negative result had a relapse of syncope. There was no statistical difference between the groups with regard to the number of syncopal episodes before patients were included in the study. Syncope in the head-up tilt test is, thus, a pointer towards identifying with a higher incidence of syncope on follow-up.

Adult↗
PubMed1994

[Therapy monitoring in cardiac arrhythmias: guidelines for evaluation of anti-arrhythmia effects].

The incidence of avoidable or unavoidable, cardial and extracardial side effects is a risk in the drug treatment of supraventricular and ventricular tachyarrhythmias. Therefore the indication of antiarrhythmic drug therapy has to be considered critically. The patient has to be controlled close-meshed, especially at the beginning of the drug treatment. In patients with life threatening ventricular tachyarrhythmias, which can not be suppressed by drug therapy, nonpharmacological therapy--implantable cardioverter/defibrillator, catheterablation and heart-transplantation--has to be discussed.

Anti-Arrhythmia Agents↗
PubMed1994

[Complications in transvenous and transvenous-subcutaneous implantable defibrillator systems].

Due to technical improvement using the transvenous-subcutaneous approach for lead fixation for cardioverter-defibrillator implantation, the incidence of device implantation has extended enormously. While a significant lower perioperative mortality in transvenously implanted systems compared to epicardially fixed implantable cardioverter-defibrillator (ICD) has been proven, perioperative as well as complications during follow-up are not analyzed systematically. In 59 patients, in whom transvenous-subcutaneous ICDs had been implanted, 3 patients showed bleeding complications in the subcutaneous patch area, 1 patient showed a bleeding in the device pocket, and in 1 patient a seroma in the subcutaneous patch region was observed necessitating surgical revisions. During follow-up of 10 +/- 7 months, lead dislocations were observed in 6 patients, in another 6 patients patch crinkling was observed. There was 1 patient with a lead fracture as well as 1 patient with a bleeding in the subcutaneous patch region. Despite the high efficacy of this therapy used in patients with life-threatening ventricular arrhythmias, these potential complications have to be considered.

Adult↗
PubMed1993

[Electrocardiography and electrophysiologic findings in patients with myotonic muscular dystrophy].

Myotonic dystrophy is associated with diffuse cardiac conduction disturbances. Seven consecutive patients, all asymptomatic with respect to cardiac abnormalities, were investigated by means of ECG, Holter monitoring, and invasive electrophysiologic studies (EPS). During Holter monitoring, no abnormalities were found in any patient, except for one patient who showed single monomorphic VEBs. During EPS three patients showed conduction disturbances in the AV-node (AVN) as well as in the His-Purkinje-system (HPS) in another three patients. Except for two patients ventricular vulnerability was normal during programmed ventricular stimulation. A considerable number of asymptomatic patients with myotonic dystrophy reveals AVN- and HPS-conduction disturbances as shown during EPS.

Adult↗
PubMed1993

[Implantation of defibrillators with transvenous-subcutaneous electrode systems].

In 23 patients an integrated pacemaker-defibrillator-system with transvenous-subcutaneous lead system was implanted. Two transvenous electrodes were positioned, one in the right ventricle for sensing, pacing and defibrillation and one in the superior vena cava for defibrillation alone. Another electrode was positioned subcutaneously near the ventricular apex for defibrillation. In 22 patients (96%) the lead system could be implanted without a major complication. The defibrillation threshold for ventricular fibrillation was 16 +/- 5 joules. During follow up of 6 +/- 4 months all spontaneous tachyarrhythmias were successfully terminated. There were three complications during follow up. In 2 patients the transvenous electrode dislocated and one patient showed a sensing malfunction. In conclusion the non-thoracotomy approach is effective, reduces the perioperative risk and represents therefore a great advantage compared to peri-/epicardial lead system.

Aged↗
PubMed1993

[Serum magnesium, serum potassium and arrhythmia profile in patients with acute myocardial infarct].

In 176 patients with acute myocardial infarction (AMI) serum magnesium concentration (MGK) and serum potassium concentration (KK) were analysed during the first 48 hours after AMI. The patients rhythm was continuously recorded. In a subgroup of 70 patients a signal averaging-ECG was performed. 4.5% of the patients had a low, 55.7% a normal and 39.8% a high MGK. 14.8% of the patients had a low, 80.1% a normal and 5.1% a high KK. Ventricular arrhythmias > or = Lown IV b were found in 25% of the patients with low MGK, in 38.8% with normal and in 52.9% with high MGK. 50% of the patients with low, 62.2% with normal and 61.3% with high MGK had late potentials. There was no relation between hypomagnesemia and ventricular arrhythmias as between hypomagnesemia and late potentials. Thus, hypomagnesemia in AMI patients is rare and does not correlate with ventricular arrhythmia or delayed ventricular potentials.

Aged↗
PubMed1992

[Acute management of myocardial infarct patients in Austria (cross-sectional study of 8 intensive care units)].

8 Austrian Intensive Care Units provided data from 6,317 cases (including 1,667 cases with acute myocardial infarction) admitted during 1990 and 1991 for a documentation system offered by the Austrian Heart Foundation. Significant differences were observed between the units concerning admission policies and the use of diagnostic methods. 71% of the AMI cases were first infarctions, 10% were Non-Q-infarcts. The median of the prehospital period varied between 2.5 and 6.5 hours. The evaluation of the admission mode showed that on average 42% of the AMI cases had contact to their G.P. before hospital admission, this figure varying, however, between 24 and 90% in different areas. It seems that this contact takes place to a much lower extent in big cities. On average G.P. contact before hospital admission in AMI resulted in doubling of the duration of the prehospital period. Thrombolytic treatment was applied in 24.7% of AMI cases with a variation between 13.9 and 48.4% in the different centers. It is suggested that regular use of this kind of quality control should offer means for optimizing the acute care of infarct patients on a regional and on a national level.

Adult↗
PubMed1992

[Non-drug therapy of ventricular tachycardia/ventricular fibrillation].

In the majority of patients with ventricular tachycardia/fibrillation drug treatment is not effective. The non-pharmacological treatment of this high-risk patients is of increasing importance. In Austria about 900 patients per year need non-pharmacological treatment of malignant ventricular arrhythmias. For this purpose 4 or 5 specialized centers would be necessary.

Anti-Arrhythmia Agents↗
PubMed1992

[Value of a provocation test with diprafenone in patients with bifascicular block].

The significance of provocative tests in patients with bifascicular block is not established. We studied 14 patients with bifascicular block, syncope and documented episodes of high degree AV-block. 1.5 mg/kg Diprafenon was given after a period of at last 12 hours 1:1 AV-conduction. Electrophysiologic evaluation was performed before and after diprafenon. AV-block III could be provoked in 1 of 14 patients with Diprafenon. Therefore a total AV block occurred in 7% of patients. The low sensitivity of provocative test with Diprafenon even in patients with documented high degree AV-block prevents its application in clinical practice.

Aged↗
PubMed1991

Reductive formation of carbon monoxide from CCl4 and FREONs 11, 12, and 13 catalyzed by corrinoids.

In an earlier publication, we reported that corrinoids catalyze the sequential reduction of CCl4 to CHCl3, CH2Cl2, CH3Cl, and CH4 with titanium(III) citrate as electron donor [Krone, U. E., Thauer, R. K., & Hogenkamp, H. P. C. (1989) Biochemistry 28, 4908-4914]. However, the recovery of these products was less than 50%, indicating that other products were formed. We now report that, under the same experimental conditions, CCl4 is also converted to carbon monoxide. These studies were extended to include FREONs 11, 12, 13, and 14. Corrinoids were found to catalyze the reduction of CFCl3, CF2Cl2, and CF3Cl to CO and, in the case of CFCl3, to a lesser extent, to formate. CF4 was not reduced. The rate of CO and formate formation paralleled that of fluoride release. Both rates decreased in the series CFCl3, CF2Cl2, CCl4, and CF3Cl. The reduction of CFCl3 gave, in addition to CO and formate, CHFCl2, CH2FCl, CH3F, C2F2Cl2, and C2F2Cl4. The product pattern indicates that the corrinoid-mediated reduction of halogenated C1-hydrocarbons involves the intermediacy of dihalocarbenes, which may be a reason why these compounds are highly toxic for anaerobic bacteria.

Carbon Monoxide↗
PubMed1991

Acute myocardial infarction in juvenile patients with normal coronary arteries.

Three patients below 21 years of age presented with typical symptoms, electrocardiographic pattern, and levels of enzymes suggestive for acute myocardial infarction. Various risk factors for coronary artery disease were present in all three patients. Coronary angiography showed normal coronary arteries in all. Thus, acute myocardial infarction may be experienced even in very young patients. Clinical and angiographic findings are discussed on the basis of the existing reports in the literature.

Adrenergic beta-Antagonists↗
PubMed1989

[Silent ischemia in long-term ECG in the early post-infarct period].

101 consecutive patients (73 m, 29 f; 48 AMI, 53 IMI) under 70 years were assigned to 24 hour-Holter monitoring in the third week after first transmural infarction. ST-segment analysis could be performed in 88 patients (89%). 18 patients (20%) had episodes of ischemia which were silent in 95%. One third of these episodes occurred in the absence of physical exercise. Ischemic events displayed a circadian rhythm with a maximum between 6 and 12 a.m. There was no correlation between ischemia and the occurrence of ventricular arrhythmia. In addition, we show that visual control of automatic ST-segment analysis is a prerequisite for routine use in clinical practice.

Aged↗
PubMed1989

[Patient behavior and length of the prehospital phase in myocardial infarction].

120 of 272 consecutive patients (44%) with confirmed myocardial infarction reached hospital within three hours of onset of symptoms. Important delays were caused by the patients "treating" themselves with drugs (delay of 6.8 +/- 14.9 h) and/or other measures (11.1 +/- 15.7 h), and in 50 of 144 (35%) patients, who consulted a doctor, time-consuming diagnostic tests and therapeutic measures (10.9 +/- 12.6 h). On the other hand, severity of pain shortened the prehospitalization phase significantly (P less than 0.025). Age, time of day, infarct site or whether first-time or recurrent infarct had no influence on the time elapsed until admission to the intensive care unit. Thus advice to patients and instruction to doctors may be the most effective means of shortening the prehospital phase in patients with myocardial infarction.

Aged↗