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Biomedical subjects

L Kappenberger

Publications and source records attributed to L Kappenberger.

At least 19 recordsLinked to original sources
PubMed1995

[Permanent junctional reciprocating tachycardia: a little-known clinical entity curable with radiofrequency ablation].

We report our experience of 5 patients with the permanent form of junctional reciprocating tachycardia (PJRT), a rare form of supraventricular arrhythmia. PJRT was discovered at a mean age of 31 years (8-60 years) and the mean duration of tachycardia was 13 years (1-40 years). 4 patients had nearly incessant tachycardia and one had paroxysmal attacks. Heart rate varied between 100 and 190 beats/minute and the minimal heart rate was on average 114 beats/minute. Four patients had palpitations, 2 developed tachycardia-induced cardiomyopathy, reversible after control of the arrhythmia, and 4 had asymptomatic episodes of PJRT. ECG showed in all cases a narrow-complex tachycardia with inverted P waves in inferior leads and RP interval greater than PR. All patients presented a posteroseptal accessory pathway. 4 patients received different antiarrhythmic drugs with only partially effective results. Radiofrequency catheter ablation of the accessory pathway was performed in all patients and was successful in 4, who remained free of recurrence after a mean follow-up of 26.5 months (4-37 months). The procedure was partially successful in the 5th patient, who is now asymptomatic under sotalol. Radiofrequency catheter ablation is therefore the treatment of choice of PJRT, a rare arrhythmia which should nevertheless be known in order to treat the patient correctly and avoid progression to cardiac failure, which is not always completely reversible.

Adolescent↗
PubMed1995

[Interventional cardiology].

The evolution of cardiology over the past 25 years has been dominated by the invention and development of interventional techniques. These techniques offer 'surgical treatment' through transvascular access to the heart, avoiding therefore the classic transthoracic surgical approach. Today, coronary artery disease, valvular heart disease and arrhythmias are accessible to interventional treatments. In this article, a review is given about recent developments and results of interventional treatment for coronary artery disease with special consideration of stenting. This article should help the general practitioner or internist to guide and inform their patients suffering from coronary artery disease.

Angioplasty, Balloon, Coronary↗
PubMed1995

[Patient management following cardiac transplantation].

Prognosis of heart transplant patients has dramatically improved in the last decade thanks to the use of cyclosporine as immunosuppressive treatment. Optimal follow-up and early recognition of complications and side effects of treatment lead to longer survival and marked improvement of these patients' quality of life. However, the incidence of complications remains high and their management calls for particular care. We review our experience of heart transplantation in Lausanne and describe in detail the results and complications such as rejection, transplant coronary artery disease, hypertension, renal failure, metabolic disorders, cancer and conduction problems. Cooperation of the medical team (cardiologist, surgeon, anesthetist, general practitioner) is essential to long term success of the transplant program.

Arrhythmias, Cardiac↗
PubMed1995

[Cardiac pacemaker for the treatment of obstructive hypertrophic cardiomyopathy, a concept which is gaining ground].

Pacing reduces the sub-aortic pressure gradient in hypertrophic obstructive cardiomyopathy. This phenomenon was described long ago but only recently, with the development of sophisticated pacemakers, has it become possible to use pacemakers for the long term treatment of this disease. The acute hemodynamic improvement with pacemaker treatment is well documented. The reason for this acute and chronic improvement is of multiple origin. Pacing modulates the activation sequence of the left ventricle, reduces contractility, reduces subaortic flow velocities, influences mitral valve movement and leads to remodeling of the ventricle in the long term. All these factors together explain the clinical and hemodynamic improvement in patients suffering from hypertrophic obstructive cardiomyopathy.

Aorta, Thoracic↗
PubMed1995

Emergency endoluminal stenting for abrupt vessel closure following coronary angioplasty: a randomized comparison of the Wiktor and Palmaz-Schatz stents.

In order to compare the efficacy of two different stent types in case of bailout stenting, 65 patients, with abrupt or threatened vessel closure following coronary angioplasty, were randomly assigned to either Wiktor (Medtronic Inc., Minneapolis, MN, 33 patients) or Palmaz-Schatz (Johnson & Johnson Interventional, Warren, NJ, 32 patients) stent implantation. Stenting was technically feasible in all except one patient and immediately successful in reverting ischemia and vessel closure in 60 patients (92%). At hospital discharge, complication rates were comparable: early vessel closure, 18% (Wiktor) versus 13% (Palmaz-Schatz) (P = 0.53); any clinical event (such as death, myocardial infarction, and surgical revascularization): 18% (Wiktor) versus 22% (Palmaz-Schatz) (P = 0.71). At 6 months follow-up, these complication rates remained equal: restenosis, 38% (Wiktor) versus 27% (Palmaz-Schatz) (P = 0.42); any clinical and angiographic (vessel closure and restenosis) event: 45% (Wiktor) and 41% (Palmaz-Schatz) (P = 0.69). Baseline, direct postprocedural, and follow-up quantitative coronary analysis data were similar, with, however, an exception for the postprocedural residual stenosis [28% (24-32%) (Wiktor) and 21% (18-23%) (Palmaz-Schatz] (means and 95% confidence intervals). In conclusion, despite a discrete postprocedural angiographic benefit observed with the Palmaz-Schatz stent, the long-term clinical and angiographic outcome is similar in both treatment groups. The choice whether to implant a Wiktor or Palmaz-Schatz stent may probably be left to the discretion of the operator and his experience with one particular device.

Aged↗
PubMed1995

Unplanned use of intracoronary stents for the treatment of a suboptimal angiographic result after conventional balloon angioplasty.

This observational single-center trial examines the safety and efficacy of unplanned endoluminal stenting for the treatment of a suboptimal angiographic result (defined as a residual stenosis after angioplasty of 40% to 50% without delayed runoff as estimated by visual assessment) after conventional coronary angioplasty in native, new-onset, coronary artery stenoses. Between October 1991 and April 1994, 101 patients with suboptimal results after coronary angioplasty in new-onset lesions were treated by endoluminal Wiktor (41 patients) and Palmaz-Schatz (60 patients) stent implantation. Stenting was a technical and angiographic success in all cases. In-hospital complications were subacute closure (2%) and vascular complications at puncture site necessitating surgery (12%) or blood transfusion (3%). No myocardial infarction occurred, nor was any urgent bypass surgery performed. At follow-up restenosis was detected in 16 (20%, 80% angiographic follow-up rate) patients requiring repeat angioplasty (8%) and elective bypass grafting (4%). Myocardial infarction was not documented. However, one patient died suddenly at 5 months of follow-up. The unplanned use of intracoronary stents is a safe and effective therapeutic option for the treatment of a suboptimal angiographic result after conventional angioplasty in new-onset lesions. This approach guarantees a high immediate angiographic success but implies a considerable incidence of vascular complications at puncture site.

Aged↗
PubMed1995

Stand-by versus stent-by during percutaneous transluminal coronary angioplasty.

To evaluate the impact of a more liberal use of endoluminal stenting on the incidence of emergency coronary artery by-pass grafting, we analyzed our attitude toward abrupt or threatened closure after percutaneous transluminal coronary angioplasty from 1986 through 1993. In 3083 procedures performed, 204 (6.6%) patients had abrupt or threatened closure. The incidence of closure or threatened closure remained stable during the 8 years, ranging between 5% (1986) and 8% (1987) (p = 0.89). Endoluminal stent implantation was attempted in 92 patients and successfully achieved in 90 (98%), and emergency bypass grafting had to be performed in 41 patients. The proportion without adverse end point (death or myocardial infarction) was higher in the patients treated by endoluminal stenting than in patients treated with bypass grafting (71/90 (79%) patients vs 17/41 (40%) patients, respectively; p < 0.0001). The use of bailout stenting gradually increased from 0.4% (1986) to 5.6% (1993) of all procedures (p = 0.0001), whereas the incidence of emergency bypass grafting decreased from 2.7% (1986) to 0.7% (1993) (p = 0.04). Meanwhile, the incidence of myocardial infarction remained stable between 5.6% (1988) and 1.8% (1992) (p = 0.1), and death rates decreased from 1.4% (1988) to 0.2% (1993) (p = 0.05). It is concluded that "stent-by" is a highly effective therapeutic approach (79% in the present study) toward closure after coronary angioplasty and that, although surgical "stand-by" is certainly mandatory for selected cases, routine stand-by is questionable.

Angioplasty, Balloon, Coronary↗
PubMed1995

[Balloon angioplasty for restenosis of coronary endoprostheses].

Between March 1991 and June 1994, the authors treated restenosis (> or = 50%) of coronary endoprostheses in 17 men aged 39 to 72 years by balloon angioplasty. The stents had been implanted for de novo stenosis in 14 patients, restenosis in 1 patient and for acute occlusion in 2 patients. The vessels treated were the left anterior descending artery (1 case), the left circumflex artery (2 cases), the right coronary artery (7 cases) and venous bypass grafts (7 cases). The endoprostheses used were 5 Wallstents in 4 patients, 13 Wiktor stents in 11 patients and 2 Palmaz-Schatz in 2 patients. Clinically, the patients with restenosis presented with class II angina (6 patients), class III (8 patients) and class IV (3 patients) of the Canadian Cardiovascular Society Classification. Conventional balloon angioplasty was performed 17 months (range: 3 to 87 months) after stent implantation and resulted in immediate clinical and angiographic success (residual stenosis < or = 50% on quantitative analysis) in all patients. In particular, there were no dissections. The minimal lumenal diameter (MLD) and percentage stenosis changed from 1.04 mm (range: 0.87 to 1.20) and 72% (range: 68 to 76) respectively before stent implantation to 2.83 mm (range: 2.46 to 3.20) and 23% (range: 20 to 27) after stent implantation. Restenosis resulted in a MLD and percentage stenosis of 0.89 mm (range: 0.77 to 1.01) and 73% (range: 69 to 78) respectively. After angioplasty of the stent, they returned to 2.68 mm (range: 2.29 to 3.06) and 27% (range: 23 to 30) respectively. The patients were not anticoagulated after angioplasty.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

Autonomic imbalance assessed by heart rate variability analysis in vasovagal syncope.

In this prospective study, the autonomic modulation of the sinus node of 12 patients (mean age 28 +/- 7 years) suffering from vasovagal syncope (VVS) was compared to that of 11 sex and age matched control patients (mean age 32 +/- 4 years) by analysis of heart rate variability. Spectral indices (low frequency power [Plf], high frequency power [Phf], total power [Pt], sympathovagal balance [LF/HF]) and temporal indices, the mean of all coupling intervals between normal beats (mRR), the standard deviation about the mean (sdRR), the percentage of adjacent R to R intervals differing by more than 50 msec (pNN50), and the root mean square of variations in successive R to R intervals (rMSSD) were compared at baseline and during head-up tilt between and within groups. Baseline results were similar in both groups. During tilt testing, comparison of results between groups revealed only significantly higher sdRR and rMSSD and lower LF/HF ratio in VVS patients. Within VVS patients, comparison of temporal and spectral analysis between baseline and tilt showed a significant increase of most indices (Plf, Phf, Pt, sdRR, and rMSSD) but a comparable LF/HF ratio; in contrast, control patients exhibited only a significant increase of LF/HF ratio. In conclusion, VVS patients who developed vasovagal syncope during head-up tilt demonstrated a nonreciprocal modulation of the sinus node by the autonomic nervous system indicative of a pronounced physiological sympathetic surge along with a paradoxical vagal input to the cardiovascular system.

Adult↗
PubMed1994

[Primary ventricular fibrillation and early recurrence: apropos of a case of association of right bundle branch block and persistent ST segment elevation].

The authors report the case of a 36 year old man who presented with an early recurrence of primary ventricular fibrillation. The initial investigations were normal apart from the finding of complete right bundle branch block with persistent ST segment elevation in the right precordial leads. The recurrence was observed 6 weeks after the initial diagnosis which led to the implantation of an automatic defibrillator. This clinical case is similar to a syndrome recently described of sudden death without obvious cardiac disease but with right bundle branch block and ST segment elevation.

Adult↗
PubMed1993

Acute and long-term ventricular stimulation thresholds with a new, iridium oxide-coated electrode.

Efforts have been made to design electrodes that significantly reduce not only the acute and chronic stimulation thresholds, but also attenuate the early peaking phenomenon and polarization. At two voltage levels (2.7 V and 5.4 V, respectively), we evaluated the right ventricular stimulation thresholds obtained with a new, iridium oxide-coated electrode in ten patients who received a VVI pacemaker. Measurements were made at implant and at multiple intervals for 1 year. Pulse width stimulation thresholds at implant were as follow: 0.04 +/- 0.008 msec at 2.7 V, 0.03 +/- 0.004 msec at 5.4 V; values at 2 weeks were 0.14 +/- 0.06 msec at 2.7 V, 0.07 +/- 0.025 msec at 5.4 V; values at 3 months were 0.09 +/- 0.03 msec at 2.7 V, 0.05 +/- 0.01 msec at 5.4 V; values at 1 year were 0.08 +/- 0.02 msec at 2.7 V, 0.04 +/- 0.01 msec at 5.4 V. The maximal increase of 0.11 +/- 0.05 msec occurred at 2.7 V, 2 weeks after implant. Our results indicate that this new electrode provides low acute and long-term stimulation thresholds, as well as an attenuated early peaking phenomenon, being able to stimulate safely at 2.7 V even early after implant.

Aged↗
PubMed1992

[Complementary information from Doppler echocardiography in the electrocardiogram in the basic assessment of chronic coronary heart disease, especially following a myocardial infarct. Observations from an ambulatory cardiology clinic].

In chronic ischemic heart disease, Doppler echocardiography (DE) at rest permits semiquantitative evaluation of scarring and remodelling processes, global ventricular function and, frequently, regional wall motion state. Late complications are detected, namely infarct expansion, true and false ventricular aneurysm, mitral insufficiency, thrombus formation, and associated valvular and aortic diseases are discovered. We studied 100 patients with known chronic coronary artery disease referred for noninvasive evaluation, including electrocardiogram (ECG) and DE. In all patients, the global left-ventricular function was satisfactorily assessable. In roughly two thirds of the documented infarctions. DE confirmed the ECG diagnosis and permitted a more precise diagnosis in the majority of them in terms of localization and/or dimension of the necrosis. In one third of the patients. DE clarified inconclusive ECG tracings. Thus, the baseline noninvasive investigation with ECG and DE is a potent tool in the management of chronic ischemic heart disease, serving as a guide to further investigation and to treatment adjustments.

Adult↗
PubMed1992

Effects of dual-chamber pacing in hypertrophic obstructive cardiomyopathy.

Although attempts have been made to treat hypertrophic obstructive cardiomyopathy with right ventricular pacing, the usual treatment for those refractory to medical therapy is open heart surgery. To assess in detail the value of non-surgical therapy the effects of acute and long-term dual-chamber pacing were investigated in 13 patients with hypertrophic obstructive cardiomyopathy refractory to medical treatment. In the first part of the study, atrioventricular (AV) sequential pacing was found to reduce peak subaortic pressure gradient in 12 of the 13 patients, from 82 (SD 42) to 47 (34) mm Hg (p less than 0.002), without concomitantly reducing aortic blood pressure or cardiac output. This effect was related to AV interval. In the second part of the study, a dual-chamber pacemaker was implanted in 8 patients and programmed to the optimum AV interval for the individual (50-90 ms). Patients were followed up for up to 62 months. Pacing resulted in a significant and long-lasting reduction in severity of angina pectoris (from NYHA class 3 to 1) and dyspnoea (from NYHA class 3 to 2). Echocardiography showed no significant change in septal thickness or left ventricular contractility but there was a trend to a spontaneous decrease in obstruction. In patients with hypertrophic obstructive cardiomyopathy, synchronised and ventricular pacing at optimum AV interval for the individual reduces the intraventricular pressure gradient and improves functional tolerance. Since the effect is longlasting, such pacing should be deemed an alternative therapy to surgery in selected cases.

Adult↗
PubMed1992

[Value of physiological cardiac stimulation in the treatment of hypertrophic obstructive cardiomyopathy].

Subaortic pressure gradient in hypertrophic obstructive cardiomyopathy (HOCM) is the consequence of a dynamic obstruction of the left ventricular outflow tract linked to the presence of a hypertrophied septum. We tried to induce an altered septal motion electrically by physiologic pacing. We studied 8 patients (6 men, 2 women, mean age 60 +/- 13 years) with symptomatic HOCM, resistant to optimal drug treatment. During a hemodynamic study, dual chamber pacing significantly reduced the preexistent subaortic pressure gradient, from 69 +/- 39 to 34 +/- 26 mm Hg (p less than 0.004), without concomitant reduction of aortic pressure or cardiac output. This reduction was dependent upon a optimized AV interval. A dual chamber pacemaker (PM) was then implanted and programmed to VDD mode and optimized AV delay interval (50-90 ms), warranting full ventricular capture. The follow-up of 3 to 30 months showed a significant reduction of both angina (from NYHA class 3 to 1: p less than 0.009) and dyspnea (from 3 to 2: p less than 0.03). An echo-doppler study in 6 patients proved the persistence of the beneficial effect of the stimulation by showing a significant reappearance of the subaortic pressure gradient after switching off the PM, from 44 +/- 29 in VDD pacing mode to 77 +/- 44 mm Hg (p less than 0.02). We conclude that atrial synchronized ventricular pacing, together with an optimized AV interval, significantly reduces the outflow gradient and improves symptoms in patients with HOCM. An altered ventricular activation sequence with late septal activation is suspected to be the mechanism.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1992

[Endocavitary ablation: a new therapeutic approach to supraventricular tachycardia].

Nowadays patients suffering from supraventricular tachycardia are first treated with antiarrhythmic drugs. In refractory cases alternative treatment is antitachycardia pacemaker implantation or surgery. Recently new percutaneous catheter techniques have been developed to ablate directly the anatomical substrate responsible for the arrhythmia by delivering energy (high or low energy shock or radiofrequency) at the tip of a catheter. This article summarizes the results of clinical application of these different techniques and briefly presents our experience. The very recent studies with RF in patients with drug-refractory av nodal reentry or accessory pathway related tachycardia (WPW syndrome) report a success rate of 92-99% with a very low complication rate. If the long term success of radiofrequency is confirmed this technique will emerge in the near future as the treatment of choice in patients suffering from symptomatic supraventricular tachycardia, since it avoids expensive, longlasting drug treatment with the permanent risk of side effects.

Atrial Fibrillation↗