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Biomedical subjects

L Seipel

Publications and source records attributed to L Seipel.

At least 163 records · Page 9Linked to original sources
PubMed1984

[Clinical and electrophysiologic findings in patients with syncope following myocardial infarct].

34 patients with syncope (median number of episodes 2) which remained unexplained after thorough medical and neurological evaluation underwent an intracardiac electrophysiological study with atrial and ventricular programmed stimulation. All patients had a history of well-documented myocardial infarction 24 months (median, 3-120) prior to the electrophysiological study. During programmed ventricular stimulation 6 patients had inducible ventricular fibrillation or flutter, and 10 patients had sustained ventricular tachycardia. In 14 patients non-sustained ventricular tachycardia was induced, whereas in only 4 patients 1 to 3 repetitive ventricular responses were induced. Therapy was instituted on the basis of electrophysiologic testing. During the follow-up of 8 months (median, 1-37) 27 patients had no recurrence of syncope. Syncope persisted and remained unexplained by the electrophysiological study in 3 patients. One patient had ventricular fibrillation and two died suddenly, two of these patients after having discontinued antiarrhythmic medication 2 weeks before. Another patient died of non-cardiac cause. It is concluded that 1) the results indicate a high ventricular vulnerability (88%) in patients with unexplained syncope after myocardial infarction, 2) the evaluation by electrophysiological studies may identify the potential mechanism for syncopes, 3) electrophysiological testing offers a rationale for specific prophylactic therapy.

Cardiac Complexes, Premature↗
PubMed1984

[The development of clinical electrophysiology. Indication, complications and results of 1296 invasive electrophysiologic studies from 1971 to 1981 in Düsseldorf].

The indications, complications and results of 1,296 clinical electrophysiological studies performed in D usseldorf between 1971 and 1981 are reviewed. In the first years, bradycardias (Sick sinus, AV conduction defects) were the main indications, whereas later on tachycardias played the dominant role. This holds especially true for ventricular tachycardias. In these patients, programmed pacing was used to control the efficacy of anti-arrhythmic treatment. The complication rate was low (1%).

Arrhythmias, Cardiac↗
PubMed1984

[Function and interaction of the right and left ventricle in patients with mitral valve stenosis].

In 17 patients with mitral stenosis functional class III (NYHA) and chronic pulmonary hypertension, volumes and function of the right (RV) and left ventricle (LV) were analysed. Biplane cineventriculography of the right and left ventricle was performed subsequently and repeated 3 min after application of 1.6 mg nitroglycerin (NTG), which was given sublingually to decrease pre- and afterload. Pulmonary artery (PAP) and wedge pressures (PCW) were measured continuously. RV ejection fraction (EF) was 62.8 +/- 7.2% before and did not change significantly after NTG. RV enddiastolic volume index (EDVI) and endsystolic volume index (ESVI) was 80.7 +/- 27.2 ml/m2 and 31.7 +/- 11.9 ml/m2, respectively, and did not change significantly after NTG. Volumes and function of the LV were normal (LVEDVI: 66.5 +/- 13.5 ml/m2, LVESVI: 23.0 +/- 7.1 ml/m2, LVEF: 62.4 +/- 9.5%). Systolic PAP decreased significantly from 43.4 +/- 11.1 mm Hg before to 37.8 +/- 9.1 mm Hg after NTG (p less than 0.025) as well as total pulmonary resistance from 243 +/- 51 to 209 +/- 50.8 dynes . sec . cm-5 (p less than 0.05). No significant correlation was found between function and volumes of both ventricles. In 4 patients, however, the decrease in LV ejection fraction was associated with a considerable increase of right ventricular enddiastolic volume. Thus, the right ventricle compensates moderate pulmonary hypertension completely maintaining normal right ventricular function. If, however, septal dysfunction occurs, right ventricular insufficiency will develop in a shorter period of time.

Blood Pressure↗
PubMed1984

[Dynamics of critical stenosis in patients with unstable angina pectoris].

In 28 patients with unstable angina pectoris biplane coronary angiography was performed in the acute stage. Arteriography of the ischemia-related vessel was subsequently repeated in 14 patients after intracoronary infusion of 0.2 mg nifedipine and ten minutes later after 10 mg sublingual nifedipine (group I) and in 14 patients after intracoronary infusion of 0.4 mg 3-N-morpholinosyndnonimine (SIN-1) (group II). 17 patients were on intravenous nitroglycerin and 11 patients on high-dose oral isosorbide dinitrate therapy at the time of angiography. Pre- and postintervention, the degree of coronary stenosis of the ischemia-related vessel was determined by three morphometric methods: rmin, minimal diameter of the stenosis, Amin, planimetered area under the stenosis and minimal diameter ratio (min diam ratio), ratio of the minimal diameter of the stenosis and the pre- and poststenotic diameter. An increase in lumen was considered to be significant when two of the three parameters increased by more than 5%. Nifedipine application resulted in an increase in lumen in 13 patients of group I. After i.c. nifedipine the lumen increased by 16% and after s.l. nifedipine by an additional 9%. Combined i.c. and s.l. nifedipine increased the lumen of the critical stenosis by 24 +/- 6.8%. In 10 patients of group II, SIN-1 application was successful and resulted in a luminal increase of 28 +/- 2.6%. In more than 80% of our patients with unstable angina pectoris application of nifedipine and SIN-1 resulted in an increase of the lumen. Thus, coronary vasoconstriction seems to be the predominant mechanism next to organic stenosis in unstable angina.

Angina Pectoris↗
PubMed1984

[An optimized contrast echocardiographic method for the detection and quantification of tricuspid valve insufficiency].

In 47 patients the incidence and extent of tricuspid insufficiency (TI) was determined by two different contrast echocardiographic methods. In 18 patients severe mitral stenosis, in 7 patients combined mitral valve disease and in 6 patients severe mitral insufficiency were diagnosed by cardiac catheterisation. 3 patients had mitral and aortic insufficiency, one patient severe aortic stenosis and 2 patients aortic insufficiency. In 9 patients the study was performed after mitral valve replacement, in 1 patient after aortic valve replacement. 1 patient had no valvular heart disease. All patients underwent right heart catheterisation and biplane cineventriculography of the right ventricle within two days of echocardiography. Method A: Echocardiography of the inferior vena cava. Method B: Direct contrast echocardiography of the tricuspid valve in the short parasternal plane. Compared with the hemodynamic study, sensitivity of method A was 62% and specificity 89% in detection of TI. Both the sensitivity and specificity of method B were 100%. A TI grade I was diagnosed in 6 of 10 patients with method A and in 9 of 10 patients with method B, a TI grade II in 8 of 9 patients with method A and in 10 with method B. A severe TI (III) was diagnosed in only 4 of 7 patients with method A and in all 7 patients with method B. The results suggest that direct contrast echocardiography of the tricuspid valve in patients with rheumatic valve disease is a highly sensitive and specific method in detection and quantification of TI in comparison to the vena cava method.

Adult↗
PubMed1984

[Effect of chronic pressure and volume stress on the function of the right ventricle].

Biplane right ventricular angiography was performed in 36 patients with chronic pressure overload of the right ventricle; 12 patients additionally had tricuspid insufficiency (TI). There were 4 subgroups: patients with systolic pulmonary artery pressure less than or equal to 40 mm Hg without (group I, n = 10) and with TI (group II, n = 6), as well as patients with systolic pulmonary artery pressure greater than 40 mm Hg without (group III, n = 14) and with TI (group IV, n = 6). Compared with the normal volumes of groups I and III, a significant increase in end-diastolic right ventricular volumes (p less than 0.01) was found in groups II and IV with 112.2 +/- 22.3 ml/m2 and 116.3 +/- 27.4 ml/m2, respectively. In both groups II and IV end-systolic volumes were also significantly increased, with 51.0 +/- 10.3 ml/m2 in group II and 49.7 +/- 11.3 ml/m2 in group IV. Right ventricular ejection fraction was 53.8 +/- 11.9% in group II, 57.3 +/- 8.5% in group III and 57.8 +/- 7.3% in group IV. There was no significant difference between the ejection fraction of these groups in comparison to the normal ejection fraction of group I with 63.4 +/- 10.9%. The results suggest that the right ventricle can compensate for moderate chronic pressure and volume overload using the Frank-Starling mechanism. Overall right ventricular dysfunction is not determined primarily by the loading conditions alone. Local myocardial and septal involvement is suspected to be an important determinant of right ventricular function.

Aortic Valve Insufficiency↗
PubMed1984

Surgical treatment of ventricular tachycardias. Complete versus partial encircling endocardial ventriculotomy.

Forty consecutive patients underwent electrophysiologically guided encircling endocardial ventriculotomy as treatment for recurrent sustained ventricular tachycardia resulting from coronary artery disease and previous myocardial infarction. Twelve patients (30%, Group I) had a complete encircling endocardial ventriculotomy and 28 (70%, Group II) had a partial encircling endocardial ventriculotomy (54.4% +/- 2.2% of the left ventricular endocardial circumference) at the earliest electrical activation during ventricular tachycardia. There were no significant differences between the two groups in age, sex ratio, New York Heart Association class, coronary disease, aneurysm location, concomitant bypass grafting, and left ventricular function. One patient of Group I and two patients of Group II did not survive the perioperative period (8% versus 7%, not significant). The survivors were restudied electrophysiologically about 3 weeks after the operation. Eight patients of Group I and 19 patients of Group II were free of ventricular tachycardia (no spontaneous or inducible ventricular tachycardia) without antiarrhythmic drugs (73% versus 73%, not significant). The mean follow-up period in Group I is 22.6 months and in Group II, 15.2 months. Five patients of Group I and of Group II developed severe left ventricular dysfunction (46% versus 8%; p = 0.025). Also, congestive heart failure was a significant cause of death in Group I patients (p = 0.036). In conclusion, electrophysiologically guided partial encircling endocardial ventriculotomy is highly efficient as a surgical treatment of recurrent sustained ventricular tachycardia. Complete encircling endocardial ventriculotomy offers no better ablation of arrhythmias and should be avoided because of its apparent hazards to left ventricular performance.

Coronary Disease↗
PubMed1984

[Incidence and prognostic significance of inducible ventricular arrhythmias in the early post-infarction phase].

To identify patients at risk of sudden cardiac death or sustained ventricular tachycardia (VT) after recent acute myocardial infarction, 100 patients younger than 70 years (80 male, 20 female; 47 anterior wall infarction, 53 inferior wall infarction) were studied prospectively. 25 days (mean) after onset of myocardial infarction, programmed ventricular stimulation was performed, including the introduction of single (S2) and double (S2-S3) ventricular extrastimuli both during sinus rhythm and at paced ventricular cycle lengths (S1-S1) of 500, 430, 370, and 330 ms. The end of the protocol was reached as soon as 4 or more consecutive ventricular echo beats (VE) were initiated. Four or more VE were initiated in 46% of patients, 4 to 9 VE in 21%, greater than or equal to 10 VE or sustained VT in 25%. During follow-up (15 +/- 8 months), 5 patients died suddenly (less than or equal to 1 h), and 5 further patients developed spontaneous sustained ventricular tachycardia. In 3 patients who died suddenly and 4 with spontaneous sustained VT, greater than or equal to 4 VE had been induced by programmed ventricular stimulation (sensitivity 60% and 80% respectively). With regard to sudden cardiac death and spontaneous ventricular tachycardia, the predictive value of a positive test was 15%, that of a negative (normal) test 94%. False negative results occurred in 6%, whereas 85% of all abnormal results had to be regarded as false positive, as these patients did not develop an arrhythmic event during follow-up. Thus patients after recent myocardial infarction frequently have signs of increased ventricular vulnerability during programmed ventricular stimulation.(ABSTRACT TRUNCATED AT 250 WORDS)

Arrhythmias, Cardiac↗
PubMed1984

[Clinical and electrophysiologic findings following operative therapy of ventricular tachycardias].

40 patients with sustained ventricular tachycardia underwent either complete (n = 12) or partial (n = 28) endomyocardial encircling ventriculotomy ( EEV ). All patients had coronary artery disease, mean age 54 years. Aneurysmectomy was performed in 35 patients. 30 patients also received coronary artery bypass grafts. There were 3 perioperative deaths (7.5%): 1/12 with complete and 2/28 with partial EEV . All survivors underwent programmed right ventricular stimulation postoperatively. Ventricular tachycardia was not inducible in 23 of 36 patients (64%). One patient was not studied postoperatively. In contrast, sustained ventricular tachycardia was still inducible in 13 patients. Ventricular tachycardia was considered as "clinical" tachycardia in 9 patients whereas it was a "non-clinical" form in another 4 patients. Thus the electrophysiological failure rate with regard to "clinical" forms was 25%. In 2 of 4 patients with spontaneous recurrences during the first postoperative week, sustained ventricular tachycardia could not be induced during the postoperative electrophysiological study. During follow-up (mean 18 months), spontaneous recurrence of ventricular tachycardia occurred in 2 patients. Cardiac arrest possibly due to coronary bypass occlusion occurred in 1 patient who could be resuscitated. 6 patients died late postoperatively: 4 of congestive heart failure, 1 of re-infarction and 1 of fulminant pneumonia. 3/11 patients (27.3%) with complete and 1/26 (3.8%) with partial EEV died because of congestive heart failure (p less than .03). Thus abolition of spontaneous sustained ventricular tachycardia was successfully achieved in 94.6% of cases surviving surgery (91.9% if the patient with cardiac arrest is included.(ABSTRACT TRUNCATED AT 250 WORDS)

Electrocardiography↗
PubMed1984

[Correlation of stimulus-induced ventricular echo beats and left ventricular function in patients without ventricular tachycardia].

110 patients (105 male, 5 female, mean age +/- S.D.: 52.9 +/- 5.9 years) with and without coronary artery disease were prospectively studied by programmed right ventricular stimulation (single and double premature stimuli during sinus rhythm and a paced ventricular drive of rates of 120, 140, 160 and 180 b.p.m.). The incidence of ventricular echobeats (VE) was correlated with angiographic and electrocardiographic findings. The end of the stimulation protocol was reached as soon as four or more ventricular echobeats were initiated. 0 to 3 VE occurred in 61/110 patients, 4-9 VE in 31 patients (28%), and greater than or equal to 10 VE were induced in 16 patients. Four or more VE were initiated in 68% of cases up to a paced ventricular rhythm of 120 b.p.m. after one or two premature stimuli. Patients with abnormal results of stimulation showed a tendency to an increase in the frequency of ventricular extrasystoles and couplets during long-term ECG recording. 86% of the patients with normal angiographic findings had 0-3 VE and 14% greater than or equal to 4 VE. In 49% of the patients with abnormal left ventricular function, 0-3 VE and in 51%, greater than or equal to 4 VE could be induced. The type of left ventricular contraction abnormality was significantly correlated to the results of programmed ventricular stimulation. greater than or equal to 4 VE were observed in 74% of patients with anterior wall myocardial infarction. Patients with inferior wall myocardial infarction had greater than or equal to 4 VE in 54% of cases. Ventricular tachycardia was induced in 30% of patients with anterior and in only 12% of patients with inferior wall myocardial infarction (n.s.). To conclude, this prospective study has shown a correlation between the incidence of inducible ventricular echobeats in response to programmed ventricular stimulation and left ventricular function. The prognostic significance of these findings has to be assessed.

Electric Stimulation↗
PubMed1983

[Diagnosis and therapy of ventricular tachycardias].

For the diagnosis of ventricular tachycardia the surface ECG is a sufficient diagnostic tool in most instances. Therefore, invasive electrophysiological studies are normally not indicated for diagnostic purposes, except if the tachycardia has not been documented up to now. However, invasive testing is necessary in every patient with VT for therapeutic reasons. During the study, the tachycardia is induced and terminated by programmed ventricular stimulation and the effect of different antiarrhythmic drugs tested. If no drug is able to suppress the induction of the tachycardia or to render it more difficult, alternative forms of therapy are to be considered. Implantable defibrillators and antitachycardial pacemakers are still at a developmental stage which does not allow a general application yet. In specialized centers, most of these intractable patients are undergoing electrophysiological operations. During operation the "focus" of the tachycardia is localized by means of epicardial and endocardial mapping and excluded by encircling subendocardial incision. In the last years, experimental and clinical studies are focusing on the so-called late potentials as markers for VT. These potentials can be recorded from the body surface by means of the signal averaging technique. Their clinical significance has not been fully established yet.

Cardiac Pacing, Artificial↗
PubMed1983

On the interaction between digoxin and disopyramide.

Combined oral therapy with digoxin (0.375 mg/dl) and disopyramide (300 and 600 mg/dl) in nine subjects did not alter steady-state digoxin serum concentrations just before the daily single digoxin dose. Digoxin and creatinine clearances were not changed. After a bolus IV dose of 0.8 mg digoxin, volume of distribution (from 672 +/- 176 l to 407 +/- 153 l) and elimination t1/2 beta of digoxin were reduced significantly in five subjects after 600 mg oral disopyramide daily (from 40.2 +/- 11.7 hr to 22 +/- 7.3 hr). Total clearance and digoxin distribution t1/2 alpha did not change significantly. The clinical significance of this interaction is not clear.

Adult↗