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Biomedical subjects

K den Dulk

Publications and source records attributed to K den Dulk.

43 records · Page 3Linked to original sources
PubMed1984

Management of pacemaker circus movement tachycardias.

DDD pacemakers were implanted in 11 patients of whom 5 had the capacity to conduct retrogradely to the atrium. Methods to prevent or terminate pacemaker circus movement tachycardia ( PCMT ) were evaluated in these patients. V-A conduction was assessed before implantation by incremental right ventricular pacing while recording right atrial electrograms. Following implantation and at quarterly outpatient clinic visits, V-A conduction and ability to initiate and sustain PCMT were systematically assessed by non-invasive techniques. PCMT could be induced non-invasively in all 5 patients. The methods used to reduce and terminate the incidence of PCMT were: 1) decreasing the atrial sensitivity; 2) stressing the V-A conduction system by programming a high upper rate with an appropriately short A-V interval; 3) programming a low lower rate; 4) avoiding the Wenckebach response (by programming a high upper rate); 5) medication; and 6) occasionally by using a magnet. PCMT was controlled in all patients, in 2 patients by programming measures only and in 2 with the addition of medication. One patient who refused medication had to be programmed into another pacing mode. We conclude that: 1) the presence of V-A conduction is not an absolute contraindication to the use of a DDD pacing system; 2) pacing the ventricle early enough to cause V-A block was the most useful method to terminate PCMT ; 3) future generation DDD pacemakers should prevent initiation of PCMTs while maintaining the possibility to synchronize to exercise-induced high atrial rates.

Adult↗
PubMed1984

A case report demonstrating spontaneous change in tachycardia terminating window.

A patient who received a patient-activated pacemaker system for termination of paroxysmal, drug-resistant, ventricular tachycardia is described. During the pre-implant invasive electrophysiological (EP) study and the three post-implant non-invasive EP studies, tachycardias were easily and reproducibly terminated by two stimuli using the interval scanning mode. On the fourth day post-implant, this pacing mode no longer terminated tachycardia at rest. A new pacing mode using more stimuli was then found to terminate the tachycardia reproducibly under various physiological conditions. This case report demonstrated a spontaneous change in the tachycardia terminating window and the usefulness of versatility in antitachycardia pacemaker systems.

Cardiac Pacing, Artificial↗
PubMed1983

Myocardial bridging as a cause of paroxysmal atrioventricular block.

Paroxysmal atrioventricular (AV) block was induced by exercise in an otherwise healthy young man. The only abnormalities demonstrated at comprehensive cardiac evaluation were: 1) angiographic systolic narrowing of the left anterior descending coronary artery, and 2) reversible radionuclide hypoperfusion of the septum during exercise. It is postulated that ischemia of the conduction system due to systolic milking of the left anterior descending coronary artery was responsible for the paroxysmal AV block in this patient.

Adult↗