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Biomedical subjects

L Kappenberger

Publications and source records attributed to L Kappenberger.

At least 217 records · Page 12Linked to original sources
PubMed1982

[Graded coronary dilatation (PTCA) with a double balloon catheter].

In coronary angioplasty (PTCA) stenoses over 80% can usually be passed with very small catheters only. To pass stenoses with different catheters during one procedure may be dangerous because of dissection. We therefore developed an instrument with very small tip-diameter and two balloons of different diameters in series. In 9 cases primary success was achieved and the degree of stenoses reduced from 90% to 23%. The gradient was 58 mmHg and remained only 11 mmHg after PTCA. When used with caution, the advantage of this catheter in high degree coronary stenoses is obvious.

Angioplasty, Balloon↗
PubMed1982

Hemodynamic effects of atrial synchronization in acute and long-term ventricular pacing.

The acute and long-term hemodynamic benefit from atrial synchronization in ventricular (VAT) pacing has been investigated at rest and during exercise in 10 patients undergoing pacemaker implantation for complete A-V block. The results were compared to conventional (VOO) ventricular stimulation at rates of 70 BPM and 96 BPM. Cardiac index (CI) in VAT-pacing increased at rest by 8% and during exercise by 15% more than with VOO pacing (p less than 0.01). No significant change between the two different rates of asynchronous pacing was observed. CI at rest and during exercise was unchanged after 10 weeks of VAT-pacing. CI is regulated by change of stroke volume in VOO-pacing and by heart rate only with VAT-pacing. In contrast to earlier results with asynchronous ventricular pacing, the hemodynamic benefit of pacing in an atrial synchronized mode is long-lasting. Physiologic mechanisms regulate hemodynamics during exercise and in heart failure.

Adult↗
PubMed1982

[Pseudocoarctation of the aorta (author's transl)].

Pseudocoarctation is an anomaly of the aortic arch, in which the aorta extends abnormally far cranially and then passes caudally in a double curvature. At the level of the distal curvature the lumen is indentated in a variable extent. In contrast to coarctation, a hemodynamically relevant stenosis and a collateral circulation are absent. We have observed a pseudocoarctation in three adults. All three had a systolic ejection murmur. Pseudocoarctation was combined in three cases with a bicuspid aortic valve and left axis deviation in the ECG. Two cases had slight aortic valvular disease ad an aneurysm of the membranous septum with a left anterior hemiblock in the ECG. According to the chest x-rays the differential diagnosis includes especially coarctation, an aortic aneurysm and a tumor of the mediastinum. Isolated pseudocoarctation requires no specific treatment.

Aged↗
PubMed1981

[Rhythm disorders in the rehabilitation phase after myocardial infarct].

45 patients with uncomplicated myocardial infarction and on no cardiac drugs underwent an exercise test and 24-hour monitoring 53 (range 22-80) days after the acute event before entering a 4-week rehabilitation program. These same tests were repeated 21 days later. Severe ventricular arrhythmias were registered in 14 patients (31%) while monitored on tape, in only 1 patient during exercise. Arrhythmias were more common in patients with ST-depression during exercise (38%) and in patients with reduced work capacity (42%). Non-smokers had no severe arrhythmias. The rehabilitation program had no influence on these findings. Arrhythmias after myocardial infarction correlate with work capacity and myocardial ischemia.

Adult↗
PubMed1981

[The frequency of sudden heart death in coronary heart disease].

229 unoperated male patients with at least 50% obstructive lesions of at least one major coronary artery were followed for 1604 patient years (7 years per patient). 88 deaths were observed during this period. 54 of the 79 cardiac deaths (68%) were sudden. The percentage of sudden cardiac death was 74% for three-vessel disease, 83% for left main lesions, 81% for ejection fraction (EF) over 0.50 and 75% for EF under 0.36. It is concluded that sudden cardiac death is likely to occur just as well with normal EF (but three-vessel or left main disease) as with severely reduced EF.

Coronary Angiography↗
PubMed1981

[Technic and long term results of pacemaker treatment with atrial electrodes].

A new implantation technique in the upper lateral part of the right atrium has reduced the complication rate of atrial electrodes to less than 4% at 11 months' follow-up. P-wave amplitude and acute and chronic threshold are in the order of conventional ventricular electrodes. In 10 of 56 patients with atrial-triggered ventricular pacemakers the cardiac output at rest and during exercise was found to be respectively 8% and 17% higher than with fixed-rate ventricular pacing. This hemodynamic benefit is longlasting, in contrast to findings with non-atrial synchronized pacing.

Adult↗
PubMed1981

[Surgical treatment of heart rhythm disorders].

Six patients underwent cardiac surgery for refractory tachyarrhythmias. Four had Wolff-Parkinson-White syndrome and 2 ventricular tachycardias after myocardial infarction. The results of preoperative electrophysiologic studies corresponded in 5 cases to intraoperative findings of epicardial and pace-mapping. These patients were free of symptoms for the 4-16 months' follow-up. In one patient with divergent results, tachycardia and preexcitation returned two months postoperatively. In the light of the foregoing the authors suggest surgical treatment for 1. preexcitation with life-threatening arrhythmias, 2. refractory ventricular tachycardias with coronary artery disease and 3. preexcitation in patients undergoing open heart surgery for other reasons.

Adult↗
PubMed1981

[Unstable angina pectoris: definition, pathology, clinical course].

Unstable angina pectoris signifies an ischemic heart condition intermediate between chronic stable angina and acute myocardial infarction. Numerous descriptive terms have been used and therefore a definition has been selected which helps in making therapeutic decisions. The cause of instability may be either a fixed coronary lesion or probably more often, dynamic events such as spasm. The course under medical treatment appears to be better than is commonly thought.

Angina Pectoris↗
PubMed1981

Programmed stimulation for long-term treatment and non-invasive investigation of recurrent tachycardia.

Eleven patients with recurrent tachycardia refractory to drugs were treated by a pacemaker system that consisted of an implanted QRS triggered stimulator activated by the application of stimuli to the patient's skin. These skin stimuli are derived by a small control box carried about in the pocket or handbag and which the patient holds in his hands to make contact with the electrode plates during a tachycardia attack. If the heart rate is higher than the preset value on the control box, timed stimuli are delivered to the skin. The tachycardia is stopped by a premature ventricular contraction induced during the "termination window", a period that occurs very soon after the refractory period. The skin impulses continue to be delivered until the tachycardia stops. The eleven patients were followed up for more than 2 1/2 years and about 2000 episodes were reliably stopped by this pacemaker system. Patients do not feel the skin stimuli and there were few complications.

Adult↗
PubMed1981

[Differentiated pacemaker therapy].

17 patients were treated by atrial (AAI) or atrial-triggered ventricular pacing (VAT). The atrial electrode was placed using a new endocardial screw-in technique. No complications occurred during a follow-up period of 3 months. Cardiac output at rest was measured in 12 patients before pacemaker implantation and was 3.571/min with VVI pacing at a heart rate (HR) of 70/min and 3.97 l/min (HR 75/min) with AAI or VAT pacing (p less than 0.001). Measurement of cardiac output was repeated in 7 patients with AV-block III degrees 10 weeks after pacemaker implant and the result was 4.40 l/min (HR 77/min) on VAT stimulation. During dynamic exercise in 5 patients, cardiac output under VAT pacing was 20% higher than with VVI pacing. This difference remained unchanged after 10 weeks. It is concluded that atrial electrodes can be placed reliably by the new technique. In contrast to VVI pacing, the hemodynamic benefits of atrial-triggered ventricular pacemakers appear to be long lasting.

Adult↗
PubMed1980

[Importance of electrophysiologic heart investigation in accessory atrio-ventricular pathway].

In 13 patients with Wolff-Parkinson-White syndrome (WPW) the findings from electrophysiologic studies have been correlated with the patients' histories. Four patients had had syncopes with tachycardia and at least one episode of cardiac resuscitation (group 1). Five patients with tachycardias had never had syncope (group 2). Group 1 and group 2 had anterograde conduction over an accessory atrio-ventricular pathway (AAVP) during investigation, while 4 patients had concealed pathways (group 3). Age, localization of AAVP, duration of tachycardia history and heart rate during regular tachycardia did not differ in the three groups. Atrial and anterograde effective refractory period of AAVP was shorter in group 1 (280 +/- 10 msec) than in group 2 (328 +/- 15 msec). Shortest RR-interval during atrial fibrillation was 230 +/- 30 msec in group 1 versus 295 +/- 10 msec in group 2. It is concluded that potentially dangerous tachyarrhythmias are due to short refractory period of AAVV. Patients with syncope and WPW-syndrome should undergo electrophysiologic investigation and be selected for controlled antiarrhythmic treatment or surgical dissection of AAVP.

Adult↗
PubMed1980

[Stimulation rate of lithium powered pacemakers in the event of battery depletion].

Between 1976 and 1977, 347 lithium powered pacemakers with capacity below 1.8 Ah have been implanted at Zürich University Hospital. 25 (7%) had to be explanted after an average of 37.3 months because of premature battery depletion, the reason for which was low resistance electrodes (Elema EMT 588 A and C) in CPI-502 UD and Telectronics 150B. Both types showed a drop in stimulation rate as an EOL-characteristic, as predicted by manufacturer. Rate controls at 6 month intervals have proven a reliable means of detecting premature failure. With ARCO Li-3D, prediction of battery depletion was possible only in one case out of 5 because of sudden and unpredictable EOL. In pacemaker dependent patients this type should be explanted by the end of the guarantee period at the latest.

Coronary Disease↗
PubMed1980

[The anatomical substrate for the Wolff-Parkinson-White syndrome].

Morphological demonstration by serial sections of accessory atrio-ventricular connections in patients with Wolff-Parkinson-White syndrome is time-consuming. However, knowledge of the extent and relative position of the accessory muscle bridge is the essential basis for surgical therapy. In three patients with electrophysiologically and electrocardiographically demonstrated WPW syndrome the accessory pathway is demonstrated at the expected site. In three controls there was no evidence of such atrio-ventricular connections.

Adult↗
PubMed1979

[Atenolol in the treatment of angina pectoris].

18 patients with angina pectoris participated in a double blind trial with atenolol (100 mg and 200 mg once daily, or 100 mg twice daily) and propranolol (80 mg twice daily). The number of anginal attacks (NAP), the number of days free of pain (NAFT), consumption of sublingual nitroglycerin (NNT) and bicycle ergometry data (EFE) were recorded. Atenolol given in a dose of 100 g twice daily significantly reduced NAP and NNT as compared with the other dose schedules for atenolol and propranolol. There was, however, no difference between NAFT and EFE under any of the treatment schedules mentioned above. Only with 100 mg atenolol twice daily was it possible to reduce heart rate at rest and immediately after exercise testing, and also diastolic blood pressure (at rest, upright and after stress testing). In spite of the long plasma T 1/2 (= 24 hours) reported by others, atenolol given twice daily seems to be the most effective schedule. It is concluded that atenolol (100 mg twice daily) has a more potent anti-anginal effect than propranolol (80 mg twice daily). In addition, atenolol has the advantage of being cardioselective.

Aged↗
PubMed1979

[Method for long-term pacemaker treatment of refractory reentry tachycardias].

A new method for pacemaker treatment of refractory reentry tachycardias has been developed which in 5 patients proved effective over a period of up to ten months. The system consists of a modified QRS-synchronous pacemaker and an external trigger unit. During tachycardia the external unit senses pacemaker spikes and by timed skin stimulation activates the implanted pacemaker to provoke the ventricular premature beats necessary for interruption of the tachycardia. The system also allows repetitive non-invasive programmed stimulation of the heart.

Adult↗
PubMed1979

[Pacemaker implantation under local anesthesia].

102 pacemakers have been implanted under local anesthesia. The electrodes have been introduced through the left vena cephalica and the pacemakers placed in the infraclavicular groove. Exchanged pacemakers have been put in the already existing cavity. The wounds have been closed by sutures consisting solely of polyglycolic acid. One hematoma and one infection have been observed. In 12% of the cases the electrode was introduced through the vena jugularis externa, owing to obstruction or unsuitable size of the vena cephalica. Reoperation was necessary in 3 cases due to dislocation of the electrode, and in one case due to the perforation of the ventricle caused by the electrode.

Aged↗
PubMed1977

[The diagnosis of the sinus node syndrome].

The "specific" investigations for sinus node syndrome (SNS) in 22 patients are analyzed. SNS was defined as sinusbradycardia below 40/min and sinus-standstill over 2 sec. Atropin (1 mg i.v.), exercise test and carotid pressure were of little help in establishing the diagnosis, while Holter monitoring and sinus-node recovery time were significantly abnormal in all patients investigated.

Aged↗