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Biomedical subjects

M Levander-Lindgren

Publications and source records attributed to M Levander-Lindgren.

At least 19 recordsLinked to original sources
PubMed1988

Bradyarrhythmia profile and associated diseases in 1,265 patients with cardiac pacing.

Twelve hundred and sixty-five patients with implanted cardiac pacemakers were reviewed for known associated conditions and for the resulting bradycardia patterns. The group bradyarrhythmia profile was AV block in 75%, sick sinus syndrome (SSS) in 21% and combined arrhythmias in 4%. Thyroid diseases and acquired valvular disease were frequently associated with AV block especially of the Wenckebach type. Sick sinus syndrome occurred significantly more frequently in women (28%) than in men (26%). Isolated bradyarrhythmias (i.e., with no associated disease) were 22% of the entire group with a 26% incidence of SSS and with a significant association with previous gastric resection, pernicious anemia, and malabsorption compared to the groups with other associated diseases. Degenerative cardiac lesions caused by malabsorption and undiagnosed hypothyroidism in elderly women may contribute to the group of apparently isolated bradyarrhythmias.

Aged↗
PubMed1988

A 20-year study of endocardial pacing lead EMT 588. Lead durability and nature of failure.

A report is presented of 1253 EMT 588 endocardial leads implanted in 1063 patients. The electrode surface area was large (47 mm2) in the 473 leads implanted during 1962-1973, and small (8-12 mm2) in the 780 leads implanted in 1974-1981. Replacement of 245 leads was necessary, in 187 cases due to lead failure and in 58 because of problems with normally functioning leads, such as infection. The highest lead failure rate occurred within the first 6 months after implantation, and was mostly caused by displacement and threshold increase. The dominating cause of late failure was lead lesion. The cumulative lead survival rates for the first and the second series were 88 and 94%, respectively after 1 year, 80 and 91% after 5 years, and 72 and 84% after 9 years. The polyethylene insulation proved to be the most vulnerable part of this lead. Insulation lesions could result in corrosion and/or fracture of the steel conductors. The chronic thresholds were largely stable.

Electrodes↗
PubMed1984

Occurrence and significance of arrhythmias associated with atrial-triggered ventricular pacing.

A review of electrocardiograms from 85 patients with atrial-triggered ventricular pacing (VAT, VDD, DDD) showed that various disturbances of rhythm were relatively common, and that the effects of an arrhythmia could be aggravated by this type of pacing. In certain circumstances even potentially dangerous ventricular extrasystoles were induced by the pacemaker. Abnormal triggering, sometimes with regular sinus rhythm, could also induce tachycardia. Our observations provided indications for a pacemaker design that would avoid such disturbing effects. The best available pacer for atrial-triggered ventricular pacing is the programmable DDD type.

Adolescent↗
PubMed1984

Ten-year follow-up on 1,000 patients with transvenous electrodes.

One thousand patients given a transvenous electrode EMT 588 until mid-January, 1974, were followed up for a minimum of 10 years. Two hundred ninety-six patients survived this time or longer. Fully 30% of them were above the age of 70 when first paced. During the observation period, 34% of the survivors had electrode complications requiring electrode replacement. These occurred in almost 14% during the first year of treatment. Electrode failures during the first year were due mainly to dislocations and rises in the stimulation threshold, while later failures were caused chiefly by damage to the lead, which was caused, in part, by repeated pulse generator replacements and infections. Half of the patients who survived for more than 15 years have the original electrode, the oldest one now exceeding 22 years.

Aged↗
PubMed1984

Antibiotic prophylaxis in pacemaker surgery--a prospective study.

To evaluate the effect of antibiotic prophylaxis in pacemaker surgery, 100 patients were randomly assigned to a prophylaxis group receiving cloxacillin or to a control group with no antibiotics. Cloxacillin was given intravenously (2 g) 2 hours before operation, followed by 1 g every 6 hours for 2 days and the same dose perorally for 8 more days postoperatively. Adequate plasma concentrations were obtained in all patients. The follow-up time was 1-43 months. The infection rate was 2% (1/50) in the prophylaxis group and 14% (7/50) in the control group (p less than 0.05). The interval from operation to manifest infection was 9-35 days. In the control group the causal microorganism was Staphylococcus aureus in two patients, Staphylococcus epidermidis in two and unknown in three patients. In the only patient with infection in the prophylaxis group, a methicillin-resistant S. epidermidis was isolated. Infection was initially localized to the pacemaker pocket in seven patients, but septicemia developed in one of them and endocarditis in another. In one patient septicemia appeared initially, without local signs of infection. This study suggests that cloxacillin prophylaxis is of value in routine pacemaker surgery.

Aged↗
PubMed1983

Galvanic element produced by defective electrode insulation--a possible cause of abnormal pulse generator inhibition.

In patients with pacemaker, abnormal inhibition with prolongation of pacing intervals may cause alarming clinical symptoms. A case is described in which high current threshold in relation to voltage threshold indicated probability of an insulation defect with current leakage. Electrograms from the electrode disclosed false signals, which had appeared after replacement of a pulse generator six months earlier. A sharp bend of the wire in the tricuspid area was shown by X-ray and was accentuated by movements of the valve. Experimentally it was demonstrated that similar potentials, sufficient to inhibit a pulse generator, can be obtained from an electrode with defective insulation. A galvanic element forms between the metals of the electrode tip and the non-insulated cable, and potential variations are elicited by movement of the wire.

Arrhythmias, Cardiac↗
PubMed1982

Pacing threshold interval with decreasing and increasing output.

The study was made in 44 patients, of which 23 received a new endocardial electrode and 21 were investigated during pulse-generator replacement. Indication for pacemaker therapy was sino-atrial bradycardia in 12 patients and atrio-ventricular block in 32 patients. When the pacing threshold was determined with decreasing output it was found to be 0.6V/0.7 mA for new implantations and 2.0 V/2.0 mA with pulse generator replacement. When determined with increasing output the threshold was found to be an average 0.20 V/0.20 mA higher than when determined with decreasing output (threshold interval). The maximal difference observed was 0.70 V/0.55 mA. This threshold interval was of the same size irrespective of pacemaker indication and spontaneous activity and whether the electrode was newly implanted or not. Pacemaker ventricular block of Mobitz type I with Wenckebach periodicity was never observed.

Bradycardia↗
PubMed1982

Septicaemia and endocarditis--uncommon but serious complications in connection with permanent cardiac pacing.

Between 1971 and 1978 septicaemia was observed in 14 patients undergoing permanent pacemaker treatment. The causative microorganisms were: S. aureus (9), S. epidermidis (3), alfa-haemolytic streptococci + P. morganii (1), enterococci (1). In 4 patients, a mural endocarditis of the right atrial wall surrounding the electrode was found at operation or autopsy. The interval between the preceding pacemaker operation and onset of septicaemia varied between 2 days and 23 months (median 2 months). In 5 patients, the last operation before septicaemia was performed because of local infection in the pacemaker pocket or along the electrode. A probable portal of entry was found in 11 patients. The electrode was the origin in 8, the pacemaker pocket in one, and a focus outside the pacemaker system in 2. Of the 6 patients treated with antibiotics alone, 3 were cured, 2 died and one is still on treatment. Eight patients underwent various surgical procedures in addition to the antibiotic treatment. In 4 the electrode was completely removed. In 2 of them cardiotomy during extracorporeal circulation had to be used. All of these patients were cured. In 3 the pacemaker system was partially extracted. Only one of them was cured, one developed osteomyelitis and one died. Based on our experience, we now recommend that all foreign material should be removed, if possible, in the presence of septicaemia and/or endocarditis, and that parenteral antibiotic treatment should be given for at least 6 weeks.

Aged↗
PubMed1979

A new concept for atrial triggered pulse generators.

In order to avoid the potential risk of a short refractory period and the inconvenience of the electronic blocking mechanism at the highest synchronous rate with the conventional atrial triggered pulse generator, two more functions have been added to the normal atrial triggered (VAT) pulse generator. First, it has been designed to be ventricular inhibited; second, a highest synchronous rate detector has been added. When the highest synchronous rate of about 140 is exceeded, the atrial signals are blocked and the frequency of the basic rate generator is increased to about 130. Two patients could hardly feel the change from atrial triggered pacing to ventricular inhibited stimulation, and both were able to work at higher loads with this type of pacing compared with the conventional atrial triggered pulse generator.

Arrhythmia, Sinus↗
PubMed1978

ECG-tape recording for analysis of syncopal attacks before and during cardiac pacing.

ECG-tape recording has been utilized for diagnosis of transient attacks of syncope and dizziness both before and during cardiac pacing. The display unit can be utilized for automatic starting of the ECG writer according to markings made by the patient or bradycardia alarm. The method has proved extremely useful and convenient, which is illustrated by cases with different types of arrhythmia and pacemaker failure.

Ambulatory Care↗
PubMed1977

Detector electrode introduced by mediastinoscopy for atrial triggered cardiac pacing. A follow-up of electrode function in 82 patients.

An atrial detector electrode was introduced by mediastinoscopy in 82 patients requiring permanent cardiac pacing. There were no complications. An adequate P wave was recorded in 80 patients. During the following week, the P wave became ineffective in 5 patients; angina occurred in 2 and atrial arrhythmias in 2. Atrially triggered ventricular pacing established in 73 patients and was followed in 71 patients for a period of 1 to 113 months. In 17 cases, it had to be terminated because of an ineffective or unstable P wave,in 6 cases because of atrial arrhythmias, and in 4 cases because of advanced age and recurrent infections. The method is technically simple and place little stress on the patient.

Adult↗
PubMed1976

ECG telemetry for pacemaker check-up.

Experience from 1 000 ECG transmissions by telephone for check-up of pacemaker patients is reported. The method and its indications are described. The quality of the ECG is usually good, but sometimes there are unsuccessful transmissions, and the technical problems are discussed. An adequate analysis of cardiac pacing function could always be made. Furthermore, valuable information of different types of arrhythmia was gained on several occasions.

Arrhythmias, Cardiac↗