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Biomedical subjects

L Kappenberger

Publications and source records attributed to L Kappenberger.

At least 181 records · Page 10Linked to original sources
PubMed1988

Intravenous thrombolytic treatment for acute myocardial infarction. Effects of early intervention and early examination.

Intravenous thrombolytic treatment (streptokinase or anisoylated plasminogen streptokinase activator complex (APSAC) was given to 50 consecutive patients within 3 hours after onset of symptoms of acute myocardial infarction. Left heart catheterisation with coronary angiography and simultaneous double view left ventriculography were performed approximately 4 hours after start of thrombolytic treatment. This examination showed that the acute infarct-related coronary artery was open in 36 patients (72%) and closed in 14 patients (28%). A higher left ventricular ejection fraction was found among patients with open, than among patients with closed infarct-related artery (58.8% vs. 48.4%, p = 0.05). The group with open artery also had a lower score of regional left ventricular dysfunction (1.7 vs. 2.4, p less than 0.05, on a scale from 0-3). Single, double and triple vessel coronary heart disease was found in 22, 14 and 13 patients respectively. Mean age was lower in the group with single vessel disease as compared to double and triple vessel disease (48.4 years vs. 53.4 and 55.4 years, p less than 0.05 and p less than 0.005). Independently of whether the infarct-related artery was open or closed, there tended to be an inverse correlation between number of diseased vessels and preservation of left ventricular function (statistical significance only for single vessel versus triple vessel disease with respect to score of regional left ventricular dysfunction, 1.8 vs. 2.4, p less than 0.05). These findings suggest that early thrombolytic treatment within 3 hours of onset of symptoms may preserve myocardial tissue during the evolution of acute infarction. Furthermore, a presumably better collateralisation from adjacent coronary arteries without stenoses may be important for myocardial preservation. Finally, early angiographic examination can be performed safely and is a good support for determination of further treatment, which in the actual patients was coronary bypass surgery in 8 cases, transluminal angioplasty, PTCA, in 20 cases, and medical treatment alone in 22 cases.

Adult↗
PubMed1988

Single versus double chamber rate responsive cardiac pacing: comparison by cardiopulmonary noninvasive exercise testing.

A new double chamber rate responsive cardiac pacemaker (DDDMR) has been implanted in seven patients (four males and three females) with a mean age of 62 years. Indication for pacemaker treatment was complete AV block in two patients, complete AV block associated to sinus node disease in three patients and sinus node disease alone in two patients. Six patients underwent two maximal stress tests on a cycloergometer performed twice randomly starting with VVIMR or DDDMR. Basic work load of 50 watts was increased by steps of 25 watts every 2 minutes. Heart rate, respiratory frequency, blood pressure, exercise duration, maximal charge developed, oxygen consumption, rate pressure product, efficiency and Borg scale were compared. Our results show a general trend but no significant differences between all the measured parameters except for efficiency which was significantly higher with DDDMR. These results prove a slight improvement of cardiopulmonary performance in DDDMR pacing compared to VVIMR and also confirm the importance of atrial contribution to cardiac output on exercise.

Adult↗
PubMed1988

Catheter ablation for recurrent tachyarrhythmias. Clinical experience with two different techniques of ablation in 21 patients.

Between 1984 and 1988, 21 patients underwent catheter ablation for drug refractory arrhythmias. Nine patients presented atrial flutter, atrial fibrillation or atrial tachycardia, nine had supraventricular tachycardia (one AV nodal reentrant tachycardia, one reciprocating tachycardia due to concealed accessory pathway and seven WPW syndrome). Three had ventricular tachycardia. Fourteen patients were treated with direct current shock ablation (DC) and seven patients with radiofrequency ablation (RF). Eight patients underwent ablation of the His bundle. In six patients permanent AV block could be induced and in two first-degree AV block. All became asymptomatic (two with additional antiarrhythmic drug therapy). In four patients with WPW syndrome DC ablation of the accessory pathway was attempted. In one patient a permanent block in the accessory pathway and in another an intermittent block were obtained. In the two remaining patients with accessory pathways the ablation failed to interrupt the retrograde conduction: in one the retrograde conduction was modified; however, in the other no change could be demonstrated. Two patients underwent ventricular foci ablation, with one partial success (arrhythmia controlled with associated drug therapy) and one failure. Three patients had RF His bundle ablation (two for atrial flutter and one for atrial fibrillation). One complete atrioventricular block, one first degree AV block and one first degree AV block associated with right bundle branch block were induced. Recurrence of tachyarrhythmias was prevented only in the patient with complete atrioventricular block. RF ablation of accessory pathway was performed in three patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Atrial Fibrillation↗
PubMed1988

Emergency stenting for acute occlusion after coronary balloon angioplasty.

Acute coronary artery occlusion complicates 2-12% of the balloon angioplasty procedures, and despite repeat angioplasty, emergency surgical revascularization is often necessary. We report our initial experience with the emergency implantation of endoluminal stents for acute vessel closure after coronary balloon angioplasty. Nine patients received one stent, and two patients received two stents during the study period. Implantation was technically successful in all patients; there were no deaths, no myocardial infarctions as evidenced by Q wave on the electrocardiogram, and no need for emergency surgery. One additional patient, not satisfying the study inclusion criteria, died 16 hours after stent implantation from left ventricular failure and intractable arrythmias. Two patients in the study group had a moderate creatinine phosphokinase rise during the first 48 hours after implantation. During a median follow-up period of 3 months (range, 1-20 months), there have been no deaths and no need for elective coronary bypass surgery. One patient required emergency recanalization 3 months after implantation because of acute occlusion of the stented segment with limited myocardial infarction. Six patients have undergone control angiography, and none has developed chronic restenosis within the stented segment. For selected patients, coronary artery stenting appears to be a promising alternative to emergency bypass surgery after acute vessel occlusion during balloon angioplasty.

Adult↗
PubMed1988

[Bradycardic arrhythmias and changes in the bradycardia-induced hemodynamics by electrical and drug treatment].

Cardiac output depends at first on heart rate and second on contractility. Chronotropic incompetence means inappropriate adaptation of rate to metabolic demands and in this condition increase of cardiac output is only made possible by increase of contractility and stroke volume. The old, insufficient, or ischemic heart cannot control cardiac output appropriately by increasing contractility. This explains the different importance of bradycardia at rest or under exercise. Drug treatment is only possible if a bradycardia is vagus induced. The prevention of asystole is the first aim of pacemaker treatment and can be achieved by conventional ventricular stimulation. If long stimulation sequences are to be expected, or if there is chronotropic incompetence, a more physiologic correction of the arrhythmia has to be considered. A competent sinus node reestablishing normal AV sequence and rate control by atrial-triggered ventricular pacing results in optimal long-term hemodynamic improvement. However, in choosing the AV interval, intramyocardial conduction delay has to be considered and therefore, AV delay has to be individually adapted. With chronotropic incompetence and normal AV conduction rate, adaptive atrial stimulation will best imitate physiologic conditions while binodal disease will be treated best by rate adaptive dual chamber pacemaker.

Anti-Arrhythmia Agents↗
PubMed1987

[Multiple peripheral emboli resulting from thrombosis of a St. Jude aortic valve prosthesis].

Although thrombosis of St. Jude valve prosthesis is rare, we report a case of multiple thromboembolism in a patient who had stopped anticoagulant therapy. The consequences were very severe since two abdominal operations (colonic resection) were necessary. Since the patient was not compliant with anticoagulant therapy, aortic valve replacement was performed and a biologic valve implanted. The postoperative phase was long but the patient left the hospital after two months' treatment. This case again demonstrates the importance of anticoagulant therapy in patients with a prosthetic heart valve. Addition of dipyridamole diminished the risk of thromboembolic accident and should be added to the anticoagulant regimen.

Anticoagulants↗
PubMed1987

Intravascular stents to prevent occlusion and restenosis after transluminal angioplasty.

Occlusion and restenosis are the most common reasons that transluminal balloon angioplasty may fail to provide long-term benefit. An intravascular mechanical support was therefore developed with the aim of preventing restenosis and sudden closure of diseased arteries after angioplasty. The endoprosthesis consists of a self-expandable stainless-steel mesh that can be implanted nonsurgically in the coronary or peripheral arteries. Experiments in animals showed complete intimal coverage within weeks and no late thrombosis during a follow-up period of up to one year. We performed 10 implantations in 6 patients for iliac or femoral arterial disease; 24 coronary-artery stents were implanted in 19 patients who presented with coronary-artery restenoses (n = 17) or abrupt closure (n = 4) after transluminal angioplasty or deterioration of coronary-bypass grafts (n = 3). We observed three complications in the group with coronary disease. One thrombotic occlusion of a stent resulted in asymptomatic closure, a second acute thrombosis was managed successfully with thrombolysis, and one patient died after bypass surgery for a suspected but unfound occlusion. Follow-up in the patients has continued for nine months without evidence of any further restenoses within the stented segments. Our preliminary experience suggests that this vascular endoprosthesis may offer a useful way to prevent occlusion and restenosis after transluminal angioplasty. Long-term follow-up will be required to validate the early success of this procedure.

Angioplasty, Balloon↗
PubMed1987

[When should ventricular extrasystole be treated?].

Arrhythmias can be variable in their clinical symptoms and are mostly even asymptomatic. Suppression of arrhythmias is usually not very difficult, but the clinical value of the intervention is questionable. Only in the case of a history of myocardial infarction does treatment with beta-blockers appear to improve the prognosis, but the mechanism does not appear to be related to the suppression of arrhythmias. In view of the potentially dangerous effects of all anti-arrhythmics, extreme caution should be exercised in using them. Only in the case of a hemodynamic or symptomatic emergency should anti-arrhythmics be prescribed.

Adrenergic beta-Antagonists↗
PubMed1987

[Treatment of arrhythmia by intracardiac electrocoagulation].

Since July 1982, 12 patients have undergone catheter ablation for refractory arrhythmias. The ablated pathway was the His bundle in 8 patients, an accessory pathway in 3 patients and a ventricular reentrant circuit in 1 patient. The 8 patients in whom the His bundle was ablated comprised 3 cases of atrial flutter, 3 cases of atrial fibrillation, 1 case of atrio-ventricular tachycardia and 1 case of junctional reentrant tachycardia. Results were complete heart block in 6 of these cases, right bundle branch block and first degree a-v block in 1 case and first degree a-v block in the last case. A pacemaker was implanted in 7 patients. The total amount of energy used varied from 50 to 400 joules. In none of these 3 patients did tachyarrhythmia recur. The 3 cases with ablation of the accessory pathway comprised one success, one partial success and one failure. The energy used was 60 to 100 joules. The patient treated for ventricular tachycardia has had no new episodes of tachycardia 4 months after the procedure. The energy used was 200 joules. The mean follow-up for the 12 patients is 12 +/- 7 months. Apart from 2 episodes of thrombophlebitis, no serious complication was noted. Catheter ablation technique is a new and effective treatment for refractory supraventricular tachyarrhythmias. Concerning ventricular arrhythmias, our experience is not sufficient to allow conclusions to be drawn.

Adult↗
PubMed1987

Effect of amiodarone on sinus node function in patients with sick sinus syndrome.

The effect of amiodarone on sinus node function has been studied in 9 patients with symptomatic sick sinus node as documented by Holter-ECG. All patients had programmable dual-chamber pacemakers. Sinus node activity was assessed by intermittently inhibiting the pacemakers before and after four weeks of oral amiodarone treatment. Sinus node function was not altered by amiodarone in 5 patients but was severely depressed in 4 patients. Thus, it is concluded that amiodarone cannot be used safely in all patients with the tachybrady syndrome for the treatment of symptomatic tachyarrhythmias without concomitant pacing.

Aged↗
PubMed1986

[Intracardiac ECG].

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Arrhythmias, Cardiac↗
PubMed1985

[Alcohol and the heart].

Although the correlation between alcohol intake and heart disease has been known for a century, the information tends to be dominated by historical and anecdotal reports. The more recent literature shows that alcoholic damage leads to metabolic and structural changes in all tissues of the heart, with the result that the contractile element, coronary vessel or specific conduction tissue may fail. The resultant symptoms are heart failure, angina pectoris and arrhythmias. These correlations are discussed.

Alcoholism↗
PubMed1985

[Clinical course after surgical treatment of the Wolff-Parkinson-White syndrome].

Return-to-work studies after surgery for WPW syndrome have not previously been reported. Of 29 patients who underwent surgery for symptomatic refractory or dangerous arrhythmias, those with a follow-up period of more than 5 months were reinvestigated by their general practitioner by questionnaire. 22 patients (6 female, 16 male, mean age 35 [14-59] years) met criteria for follow-up (mean postoperative period 21.7 [5-56] months). 19 were completely symptom-free, two had palpitations due to VPB and 1 had recurrence of tachycardia. 19 are back at full-time work compared with only 13 preoperatively, 2 are working reduced hours and 1 is disabled after an accident. There were no deaths, but 1 patient was reoperated on surgical grounds. 3 patients are continuing to take vasoactive drugs. It is concluded that, in the light of clinical follow-up, 86% of patients undergoing surgery for WPW syndrome can be cured and return to work.

Adolescent↗