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Biomedical subjects

R Lal

Publications and source records attributed to R Lal.

At least 145 records · Page 8Linked to original sources
PubMed1986

Combined bipolar dual chamber pacing and automatic implantable cardioverter/defibrillator.

A 67 year old man with recurrent hypotensive ventricular tachycardia, amiodarone-induced bradyarrhythmias and severe cardiac dysfunction underwent simultaneous implantation of an automatic cardioverter/defibrillator and bipolar atrioventricular (AV) pacemaker. The pacing electrodes were placed epicardially near the right atrial appendage and on the lateral right ventricular wall. The rate detector of the automatic defibrillator was placed epicardially on the posterobasal left ventricular wall. Effective bipolar AV pacing produced no false counting of the heart rate by the automatic cardioverter/defibrillator, and ventricular tachycardia properly inhibited the pacemaker. Long-term follow-up study confirmed the safety of this treatment. With proper precautions, bipolar AV pacing can be safely combined with an automatic cardioverter/defibrillator.

Aged↗
PubMed1986

Flecainide in the treatment of nonsustained ventricular tachycardia.

Thirty-two patients received flecainide acetate for nonsustained ventricular tachycardia after having had unsuccessful treatment with a mean of four antiarrhythmic drugs. The mean left ventricular ejection fraction was 41% in 27. Thirty-one patients had organic heart disease, and 22 patients had arrhythmia-related symptoms. Total suppression of ventricular tachycardia occurred in 22 patients. Thirty patients were discharged from the hospital receiving flecainide at a mean (+/- SD) dosage of 315 +/- 76 mg/d and 26 of these patients attained a mean trough plasma drug level of 567 +/- 254 ng/mL. One patient had proarrhythmia and 3 had worsening of heart failure. Twenty-two patients remained in the trial for a mean follow-up of 13 +/- 7 months. Five patients died (1 suddenly) during the follow-up period. Our data indicate that flecainide suppresses refractory nonsustained ventricular tachycardia in 69% of patients who have organic heart disease. Serious adverse effects were minimized by initiation of treatment in the hospital and careful surveillance of electrocardiograms and plasma drug levels.

Adult↗
PubMed1985

Out-of-hospital automatic cardioversion of ventricular tachycardia.

A 42 year old man who survived sudden cardiac death was treated with an automatic implantable cardioverter/defibrillator. After a 5 month symptom-free interval, the patient received two internal discharges in the conscious state while wearing an ambulatory electrocardiographic recorder. Analysis of the tape revealed that both discharges were activated by two bursts of polymorphous ventricular tachycardia, the first one occurring at the end and the second at the onset of episodes of slow, hemodynamically stable monomorphous ventricular tachycardia. This case illustrates the reliability of the automatic implantable cardioverter/defibrillator as an antiventricular tachycardia device and the problem posed by its exposure to nonsustained ventricular tachycardia.

Adult↗
PubMed1985

Paroxysmal fascicular tachycardia: electrophysiologic characteristics and treatment by catheter ablation.

A 69 year old man with ischemic heart disease underwent electrophysiologic evaluation for paroxysmal wide QRS tachycardia, the configuration of which was identical to that recorded during sinus rhythm, that is, right bundle branch block, left anterior fascicular block and anterior myocardial infarction. Electrocardiographic recordings during tachycardia showed atrioventricular dissociation and His bundle activation occurring 5 ms after the onset of the QRS complex recorded on the surface electrocardiogram, consistent with a left posterior fascicular tachycardia. All traditional therapeutic attempts failed to prevent frequent recurrences of tachycardia, which was finally ablated by three 300 J shocks delivered through an electrode catheter positioned in the posterobasal region of the left ventricular septum.

Aged↗
PubMed1985

Short- and long-term experience with flecainide acetate in the management of refractory life-threatening ventricular arrhythmias.

Thirty-eight patients with organic heart disease and history of sudden cardiac arrest or recurrent sustained ventricular tachycardia were treated with flecainide. Coronary artery disease was present in 33 patients. Previous antiarrhythmic therapy consisted of two to eight drugs (mean four). Fourteen patients were resuscitated from sudden cardiac death and 24 patients had chronic recurrent sustained ventricular tachycardia. Twenty-eight patients had electrophysiologic testing before and during flecainide treatment. Sustained ventricular tachycardia became noninducible in 5 patients, nonsustained in 5 patients and slowed in 13 patients (cycle length increased from 278 +/- 64 to 395 +/- 91 ms; p = 0.002). Three of the 14 patients with sudden cardiac death and 15 of the 24 patients with recurrent sustained ventricular tachycardia remained on long-term flecainide treatment. The mean left ventricular ejection fraction in 16 of these 18 patients was 37%. Nonlimiting side effects occurred in seven patients (18%). Proarrhythmic effects were seen in four patients (10%). At a mean follow-up time of 11 +/- 3 months, 15 patients (39%) had had no recurrence, including 5 who had inducible sustained ventricular tachycardia and 5 who did not on retesting during treatment. In the 18 patients who received long-term therapy, 3 late deaths occurred, 1 of which was of arrhythmic origin. These data suggest that flecainide is effective in about 40% of patients with severe refractory ventricular arrhythmias. Its value as a single drug in the treatment of sudden cardiac death remains to be defined.

Adolescent↗