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Biomedical subjects

R Nadeau

Publications and source records attributed to R Nadeau.

At least 127 records · Page 7Linked to original sources

Surgical treatment of ventricular tachycardia. Regional cryoablation guided by computerized epicardial and endocardial mapping.

Extended cryoablation as a single method of myocardial ablation was used for surgical treatment of 33 patients with ventricular tachycardia associated with coronary artery disease. Surgery was guided by roving-probe mapping in 14 patients and by computerized epicardial and computerized, left ventricular, endocardial, multielectrode mapping in 19 patients. In the latter group, the anatomic correlation between sites of the earliest epicardial activation (EA-EPI) and those of the earliest endocardial activation (EA-ENDO) was found to be consistent in the apical region. In contrast, the EA-ENDO corresponding to the EA-EPI localized in the left anterolateral and posterobasal free-wall regions could be localized either in an underlying area or on the septum. All tachycardias with EA-EPI in anterior and posterior right ventricular regions had their corresponding EA-ENDOs in the interventricular septum. EA-ENDO preceded EA-EPI in 33 of 41 tachycardias studied. The converse was observed in the remaining eight tachycardias. Cryoablation was applied regionally in areas corresponding to EA-ENDO, along with standard aneurysmectomy and coronary artery bypass grafting when indicated. Among the entire group of 33 patients, there were two (6%) operative deaths. Ventricular tachycardias recurred spontaneously in two (6%) patients and remained inducible in four (13%), of whom one (3%) died suddenly. After hospital deaths were taken into account, actuarial survival was 74 +/- 9% (mean +/- SD) at 48 months after operation. Among the 10 patients who had an EA-EPI on the right ventricle and an EA-ENDO on the interventricular septum, deep septal involvement was suspected, and arrhythmic failure occurred in five patients; in contrast, complete surgical success was obtained in all nine patients who did not display this pattern during intraoperative investigation. We conclude that regional cryoablation alone in areas of the earliest left ventricular activation is highly effective for treatment of ventricular tachycardia, except in a subset of patients with specific markers of deep septal involvement, which can be detected by computerized epicardial and endocardial mapping.

Action Potentials↗

Long term efficacy and toxicity of amiodarone in the treatment of refractory cardiac arrhythmias.

Amiodarone has remarkable efficacy, but it also has a high incidence of severe side effects. Nevertheless, it is extensively used. The findings of an amiodarone treatment follow-up period of one to 72 months (mean 19 +/- 17) in 95 patients with recurrent life threatening arrhythmias resistant to other antiarrhythmic drugs are described. The mean loading dose of 800 mg/day for one week was followed by an average dose of 600 mg/day for two weeks. The long term daily dose was 400 mg in 80 patients and 200 mg in the remaining 15 patients. Amiodarone was particularly effective in suppressing complex ventricular arrhythmias. It also decreased premature ventricular beats by 83% and atrial premature beats by 41%. Supraventricular tachycardias were completely controlled and the ventricular response to atrial fibrillation was slowed. Twelve of the 95 patients (12.6%) died while taking amiodarone, two of sudden death and 10 of heart failure. Side effects were recorded in 77 (81%) patients. They were generally dose related and subsided with a decrease in dose or discontinuation of the medication. There was a correlation between the concentration of rT3 and the significance of the side effects. Thirty-nine patients stopped taking amiodarone, however, only 14 of these stopped because of toxicity: five developed pulmonary fibrosis; three had neurological toxicity; two had bradyarrhythmias; two developed hepatic dysfunction; one had hypothyroidism; and one patient suffered an aggravation of a pre-existent heart failure. It was concluded that amiodarone is a very effective treatment for supraventricular and ventricular arrhythmias. However, it does have numerous and severe side effects.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

Sympatho-adrenal and cardiovascular responses during hand-grip in human hypertension.

Circulating norepinephrine and epinephrine levels were correlated with echocardiographic indices of cardiovascular function during isometric exercise (hand-grip at 30% of maximum force for 3 minutes) in 19 patients with mild essential hypertension and 9 normotensive subjects. At the end of the third minute of exercise, plasma norepinephrine and epinephrine, blood pressure and heart rate, increased significantly and similarly in both groups of patients. In contrast, peripheral resistance tended to increase in hypertensives but tended to decrease in normotensives. Moreover, indices of ventricular function increased in normotensives but decreased in hypertensives. At the end of the exercise, systolic and diastolic blood pressures were directly correlated with epinephrine levels in normotensives but were correlated only with norepinephrine levels in hypertensives. On the other hand, norepinephrine and epinephrine levels were inversely correlated with changes in indices of left ventricular performance in hypertensive patients only. These results demonstrate that during isometric exercise, the increase in blood pressure in normotensives is associated with a sympatho-adrenal activation of cardiac performance and contractility, while in hypertensives the increase in blood pressure results mainly from an increase in peripheral resistance associated with a reduction in cardiac performance and contractility, despite a similar sympatho-adrenal activation in both groups. These differences in the hemodynamic responses may be compatible with the hypothesis of beta-adrenoceptor desensitization or structural alterations of the cardiovascular system in hypertensive patients.

Adrenal Glands↗

Effect of intravenous and oral calcium antagonists (diltiazem and verapamil) on sustenance of atrial fibrillation.

Both verapamil and diltiazem are used to control ventricular response during atrial fibrillation (AF). Their effect on the maintenance of AF is not known. The effects of the intravenous and oral administration of verapamil and diltiazem were investigated in 35 patients, 18 with (group I) and 17 without (group II) documented paroxysmal AF. Programmed electrical stimulation, either extra-stimuli or burst atrial pacing, was used to induce AF. In group I, the mean values of the duration of AF before and after the intravenous and oral administration of the calcium antagonists were 31 +/- 12, 112 +/- 49 and 69 +/- 25 minutes, respectively. For group II, the values were 5 +/- 3.4, 39 +/- 13 and 14 +/- 7 minutes, respectively. The differences were statistically highly significant (p less than 0.001), after both oral and intravenous administration compared with the baseline value in both groups. The data suggest that both intravenously and orally administered calcium antagonists enhance sustenance of electrically induced AF, especially in patients with spontaneous arrhythmia. Thus, in patients with paroxysmal AF, verapamil or diltiazem should be administered cautiously, because these drugs may prolong the duration of arrhythmia. Further studies are warranted to investigate the role of calcium antagonists in spontaneously occurring paroxysmal AF.

Administration, Oral↗

Local modulation of adrenal catecholamines release by beta-2 adrenoceptors in the anaesthetized dog.

The release of adrenal catecholamines into the adrenal vein elicited by splanchnic nerve stimulation, was evaluated in the presence of a beta-adrenoceptor agonist and both beta-1 and beta-2 adrenoceptor antagonists in anaesthetized and vagotomized dogs. Stimulations (0.5 V pulses of 2 ms duration for 3 min at 1 Hz) were applied before and after the i.v. infusion of the beta-adrenoceptor agonist, isoproterenol (0.1 microgram/kg/min). While maintaining the infusion of isoproterenol, either ICI 118551 (0.3 mg/kg), a selective beta-2 adrenoceptor antagonist, or 204-155 (0.2 mg/kg), a selective beta-1 adrenoceptor antagonist (Sandoz Co., Dorval, PQ, Canada), were injected intravenously and the stimulation was repeated. The results show that isoproterenol increased significantly both pre-stimulation basal levels and the stimulated release of catecholamines. These potentiated responses were significantly reversed by ICI 118551, but not by 204-155. These results suggest that the release of adrenal catecholamines is locally modulated by a positive feedback mechanism through activation of beta-2 adrenoceptors.

Adrenal Medulla↗

Modulation of adrenal catecholamine release by DA2 dopamine receptors in the anaesthetized dog.

1. The effects of DA2 agonist, quinpirole (50 micrograms/kg, i.v.) and a DA2 antagonist, domperidone (50 micrograms/kg, i.v.) on the release of adrenal catecholamines were evaluated in the anaesthetized and vagotomized dog. 2. Stimulations (5 V pulses of 2 ms duration for 3 min) of the splanchnic nerve at frequencies of 1, 3 and 5 Hz were applied randomly before and after injection of the drug. 3. The results show that quinpirole reduces significantly the release of adrenaline at 1 and 3 Hz but not at 5 Hz, while the release of noradrenaline is reduced at 1 Hz but not at 3 and 5 Hz. Inversely, domperidone potentiates significantly the release of both catecholamines at 3 and 5 Hz, but not at 1 Hz. 4. There was no change in basal release of adrenal catecholamines, adrenal blood flow or heart rate after both drug treatments. 5. The mean arterial pressure was not affected by domperidone treatment but there was a significant reduction in basal mean arterial pressure after the injection of quinpirole. 6. There was no change in any of these parameters during electrical stimulation. 7. Therefore, these results strongly suggest that DA2 dopamine receptors are present at the level of the adrenal medulla and that their activation could mediate an inhibitory modulation on the adrenal catecholamines release within a certain range of electrical stimulation.

Adrenal Glands↗

In vivo modulation by alpha 2-adrenoceptors of adrenal catecholamine release in the anaesthetized dog.

In this study, the reversal of the potentiating effect of idazoxan, a selective alpha 2-antagonist, on adrenal catecholamine release elicited by splanchnic nerve stimulation in anaesthetized and vagotomized dogs, was investigated with the use of oxymetazoline, a selective alpha 2-agonist. Stimulation of the left splanchnic nerve (5.0-V pulses of 2 ms duration for 3 min at a frequency of 2 Hz) was applied before and 20 min after the i.v. injection of each drug. Blood samples were collected in the adrenal vein before and at the end of each stimulation. The results show that the release of catecholamines induced by electrical stimulation was potentiated by 50% after idazoxan injection (0.1 mg/kg). This enhanced response was significantly antagonized by the subsequent injection of oxymetazoline (2 micrograms/kg). The alpha 2-modulating effect appears to be related to the amount of catecholamines released during the stimulation, since by subgrouping of the data on the basis of the degree of potentiation by idazoxan, it was observed that this drug was more efficient when catecholamine release was higher during control stimulation. In contrast, the reversing effect of oxymetazoline was found to be more pronounced when catecholamine release was lower. These results thus suggest that the sensitivity of the alpha 2-adrenoceptor mechanism may depend upon the in situ concentration of adrenal catecholamine release during electrical stimulation and that the potentiating effect of alpha 2-blockade can be reversed by activation of those receptors by a selective alpha 2-agonist.

Adrenal Glands↗

Coronary sinus norepinephrine concentrations during ventricular tachycardia induced by left stellate ganglion stimulation in dogs.

Coronary sinus catecholamine overflow was measured in open-chest dogs, anesthetized with sodium thiopental and alpha-chloralose, during left sympathetic stimulation. Uniform ventricular tachycardias were induced in 9 out of 16 dogs during either left stellate ganglion or left ventrolateral cardiac nerve stimulations. Significant increases in norepinephrine (8.1 ng/mL, plasma) and epinephrine (0.19 ng/mL, plasma) overflows were obtained after 30 and 90 s of stimulation, respectively. Maximum norepinephrine overflow was significantly higher in dogs with ventricular tachycardia than in those without it (16.0 vs. 7.4 ng/mL, p less than 0.05). This suggests that the induction of ventricular tachycardia in the normal myocardium is related to the amount of local secretion of norepinephrine during nerve stimulation.

Animals↗

In vivo interactions between prejunctional alpha 2- and beta 2-adrenoceptors at the level of the adrenal medulla.

The combined effect of a beta 2-antagonist and an alpha 2-agonist on the release of adrenal catecholamines was studied in the anaesthetized and vagotomized dog. The electrical stimulation of the splanchnic nerve (5-V pulses of 2 ms duration for 3 min at a frequency of 3 Hz) produced a significant rise in adrenal catecholamine release in the adrenal vein. Intravenous injection of a beta 2-antagonist significantly reduced this response and a subsequent injection of an alpha 2-agonist further reduced the release of catecholamines. However, if the alpha 2-agonist is injected first, the release is not different compared with the control stimulation, and the subsequent injection of the beta 2-antagonist also did not modify the release in response to electrical stimulation. These results suggest that the blockade of presynaptic beta 2-receptors reduces the release of adrenal catecholamines without interfering with the activation of the alpha 2-adrenoceptors. In contrast, the pretreatment with the alpha 2-agonist, which does not modify the release of catecholamine at 3 Hz, seems to interfere with the inhibitory effect of the beta 2-antagonist.

Adrenal Medulla↗

Demonstration of hysteresis in refractoriness of canine ventricular myocardium.

The properties and determinants of hysteresis during ventricular effective refractory period (VERP) measurements by an extrastimulus technique were determined in 15 anesthetized open-chest dogs as well as in isolated ventricular muscle (n = 6). VERP was determined both by decreasing the S1-S2 interval and also by increasing S1S2. Hysteresis was then calculated by subtracting the VERP obtained with the decreasing S1S2 from the VERP obtained with the increasing S1S2. The effects of basic cycle length, pulse width, stimulation intensity, and the number of basic drives on VERP and hysteresis were evaluated. VERP was shorter for long pulse width, high stimulation intensities, and shorter basic cycle lengths. These modifications were not associated with significant changes of hysteresis. VERP was shorter during decreasing S1S2 than during increasing S1S2. Hysteresis was greater with 6 basic drive cycles than with 12 (P less than 0.001) in both in vivo and in vitro preparations. The data suggest that 1) hysteresis occurs during VERP measurements; 2) hysteresis is independent of stimulation modality; and 3) hysteresis decreases with the number of basic drive cycles.

Animals↗

Epinephrine release from the heart during left stellate ganglion stimulation in dogs.

Plasma epinephrine (E) and norepinephrine (NE) concentrations were measured (radioenzymatic assay) in blood samples simultaneously withdrawn from the aorta (Ao) and coronary sinus (CS) on 10 anesthetized dogs immediately before and during a 1-min period of electrical stimulation of the left stellate ganglion (4 V, 4 ms, 10 Hz). Heart rate and systolic blood pressure significantly increased in response to electrical stimulation (152 +/- 8 to 180 +/- 15 beats/min and 128 +/- 12 to 149 +/- 12 mmHg, mean +/- SE; P less than 0.05). Plasma NE concentrations were not significantly different in the Ao and the CS (432 +/- 110 and 319 +/- 67 pg/ml) before the stimulation, whereas a net removal of E was present across the myocardium (Ao, 172 +/- 61; CS, 71 +/- 22 pg/ml). A large NE spillover in the CS was observed during the stimulation (Ao, 1,555 +/- 513; CS, 10,583 +/- 3,753 pg/ml). A significant output of E from the myocardium was also present (Ao, 165 +/- 42; CS, 291 +/- 74 pg/ml) during the stimulation. Determination of NE and E concentrations by high-performance liquid chromatography in five of the dogs confirmed the observation made with the radioenzymatic assay, i.e., a significant uptake (66%) of blood-borne E was present across the myocardium in the control situation (Ao, 320 +/- 97; CS, 110 +/- 23 pg/ml), whereas plasma E concentrations in the CS (280 +/- 61 pg/ml) were 1.5 times the values found in Ao (184 +/- 56 pg/ml) under electrical stimulation. These observations give further support to the hypothesis that endogenous tissue E can act as a cotransmitter of sympathetic fibers.

Animals↗

Regional plasma catecholamine removal and release at rest and exercise in dogs.

Dynamics of circulating catecholamines (CA) were studied at rest (heart rate = 104 +/- 3 beats/min) and during mild treadmill exercise (heart rate = 168 +/- 5 beats/min) in 60 dogs. Plasma epinephrine (E) and norepinephrine (NE) removal from circulation and release into circulation were estimated from plasma CA arteriovenous differences across the regional vascular beds studied (pulmonary, myocardial, hepatosplanchnic, renal, and skeletal muscle vascular beds) and from regional blood flows. Regional plasma E fractional extraction (PEFE) was used as an index of NE removal from plasma. Arterial plasma CA increased significantly from rest to exercise (P less than 0.05). A significant PEFE was observed at rest and exercise across all studied vascular beds but the pulmonary bed. When plasma flow was taken into account, the largest contributors to plasma CA removal were the hepatosplanchnic vascular bed at rest and skeletal muscle vascular beds during exercise. At rest, the hepatosplanchnic vascular bed was a major contributor to the plasma NE pool. During exercise, main contributors to NE release into plasma were skeletal muscle vascular beds. Circulating CA kinetics did not appear to vary from rest to exercise. Clearance and apparent distribution space were estimated to be, respectively, 1.5 l/min and 2 liters for circulating E and 2 l/min and 5 liters for NE at rest and exercise. Circulating E and NE half times were estimated to be approximately 1 and 1.8 min, respectively.

Animals↗

PQRST isoarea maps from patients with the Wolff-Parkinson-White syndrome: an index for global alterations of ventricular repolarization.

Isoarea maps during the PQRST sequence were computed in 22 healthy subjects and 48 patients with Wolff-Parkinson-White (WPW) syndrome. Thirty-eight patients with WPW were on no medication and 10 were treated with class I, II, or III antiarrhythmic drugs. Seventeen isoarea maps were recorded before and 17 were recorded after accessory pathway ablation. One patient had intermittent preexcitation. Body surface maps from all healthy subjects were similar, although the magnitudes of the maxima and minima showed significant variability. In all patients with WPW who were on no medication and in those on class I and II agents, PQRST maps were normal. Two patients taking amiodarone had abnormal PQRST maps, as did patients early after surgery. In the patient with intermittent preexcitation, PQRST maps were very similar during normal and preexcited beats. In conclusion, our results support the theory that the PQRST time integral reflects intrinsic recovery properties of the heart and is independent of the activation sequence.

Adult↗

Tachycardia cycle length and maximum capacity of anterograde and retrograde atrioventricular conduction in paroxysmal supraventricular tachycardia.

Anterograde and retrograde pathways are the two major components of the reentry circuit in patients with paroxysmal supraventricular reentrant tachycardias. Therefore, the capacity of each pathway to maintain 1:1 conduction would be expected to determine the cycle length (CL) of the tachycardia. In this study, the possible relationship between the CL of reentrant tachycardia and the maximum capacities of anterograde and retrograde conduction in the maintenance of a 1:1 response during atrial and ventricular pacing were examined. This relationship was analyzed in 26 patients with orthodromic reentrant tachycardia due to Wolff-Parkinson-White syndrome (group 1) and compared with that in 26 patients with atrioventricular nodal reentrant tachycardia (group 2). There were no statistically significant differences between the two groups in the shortest tachycardia CLs (mean +/- SD, 325 +/- 44 versus 329 +/- 52 ms); in the shortest ventricular pacing CLs with 1:1 response (314 +/- 63 versus 319 +/- 38 ms); nor in the CLs that produced retrograde atrioventricular block (306 +/- 62 versus 301 +/- 37 ms). In contrast, the longest atrial pacing CL that produced Wenckebach's phenomenon and the shortest atrial pacing CL with 1:1 response were significantly shorter for group 1 than for group 2 patients (290 +/- 38 versus 390 +/- 88 ms, P less than 0.001) and (305 +/- 38 versus 406 +/- 90 ms, P less than 0.001), respectively. It was concluded that the CL of orthodromic tachycardia can best be predicted from the shortest atrial pacing CL that maintains 1:1 anterograde conduction via the normal pathway.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

Efficacy and safety of intravenous and oral diltiazem for Wolff-Parkinson-White syndrome.

The electrophysiologic effects and safety of diltiazem administered either intravenously or orally were studied in 14 patients with Wolff-Parkinson-White syndrome during orthodromic reentrant tachycardia and atrial fibrillation (AF). Anterograde and retrograde effective refractory periods of the accessory pathway did not change significantly from baseline during either i.v. or oral administration. Administration by either route prevented induction of sustained reentrant tachycardia in 8 patients. In 6 patients, the reentrant tachycardia was either nonsustained (2 patients) or sustained at much slower rates than the baseline rates (mean +/- standard deviation, baseline, 290 +/- 41 ms; i.v., 355 +/- 40 ms [p less than 0.001]; and oral, 377 +/- 33 ms [p less than 0.001]). In these patients anterograde atrioventricular conduction was prolonged significantly from the mean baseline value of 163 +/- 36 ms to 212 +/- 35 ms with i.v. administration (p less than 0.005) and 225 +/- 33 ms with oral administration (p less than 0.005). Retrograde conduction via the accessory pathway did not change significantly after administration of diltiazem. The shortest preexcited RR intervals during AF were significantly reduced during i.v. but not during oral administration: control, 327 +/- 47 ms; i.v., 270 +/- 28 ms (p less than 0.001); and oral, 323 +/- 44 ms (difference not significant). In 5 patients AF was sustained for a mean of 20 minutes after i.v. and for 12 minutes after oral administration (p less than 0.20), compared with a baseline mean value of 0.83 minute.(ABSTRACT TRUNCATED AT 250 WORDS)

Administration, Oral↗

Effect of autonomic nervous system modulation on retrograde atrioventricular nodal conduction in the human heart.

Although the influence of the autonomic nervous system on anterograde atrioventricular nodal conduction is well established, its effect on retrograde atrioventricular nodal conduction has not been examined systematically. Since retrograde atrioventricular nodal conduction in subjects with normal anterograde conduction may vary from intact retrograde conduction to complete retrograde block when assessed during ventricular pacing, in this study patients with (a) intact retrograde atrioventricular nodal conduction (group 1) were studied during parasympathetic (vagal) stimulation by carotid sinus pressure and during sympathetic inhibition (propranolol 0.2 mg.kg-1 intravenously) and (b) retrograde atrioventricular nodal block (group 2) were studied during vagal blockade (atropine 0.04 mg.kg-1 intravenously) and during sympathetic stimulation (isoproterenol 1-4 micrograms.min-1 infusion). In both groups changes in sinus cycle length and anterograde atrioventricular nodal conduction were measured. In group 1 vagal stimulation by carotid sinus pressure in 20 patients caused the cycle length at which retrograde atrioventricular nodal block was induced to be significantly lengthened from a mean(SD) of 375(59) to 451(51) ms in six patients; caused complete retrograde block in 10 patients; and had no effect in four patients. Sympathetic inhibition by propranolol in another 15 patients delayed the onset of pacing induced retrograde atrioventricular nodal block from a mean(SD) of 340(60) to 418(80) ms in 11 patients; caused complete retrograde atrioventricular nodal block in three patients; and had no effect in one patient. In group 2 vagal blockade by atropine caused a 1:1 retrograde response during ventricular pacing up to a mean(SD) cycle length of 470(135) ms in six out of eight patients. The infusion of isoproterenol caused the retrograde atrioventricular nodal block to be abolished and 1:1 conduction to be resumed up to a ventricular pacing mean(SD) cycle length of 364(57) ms in six out of eight patients. It is concluded that (a) the autonomic nervous system modulates retrograde atrioventricular nodal conduction in a similar manner to its anterograde counterpart and (b) that since retrograde atrioventricular nodal conduction was reversible after the administration of either atropine or isoproterenol retrograde atrioventricular nodal block may be dynamic (physiological) rather than fixed (anatomical) in nature.

Adult↗

The release of catecholamines from the adrenal medulla and its modulation by alpha 2-adrenoceptors in the anaesthetized dog.

The adrenal nerve of anaesthetized and vagotomized dogs was electrically stimulated (10 V pulses of 2 ms duration for 10 min) at frequencies of 1, 3, 10, and 25 Hz. There was a correlation between the frequency of stimulation and the plasma concentrations of epinephrine, norepinephrine, and dopamine in the adrenal vein, mainly after the 1st min of stimulation and the maximal concentration was reached sooner with higher frequencies of stimulation. Moreover, the relative percentage of catecholamines released in response to the electrical stimulation was not changed by the frequency of stimulation. To test the hypothesis that a local negative feedback mechanism mediated by alpha 2-adrenoceptors exists in the adrenal medulla, the effects of the systemic administration of clonidine (alpha 2-antagonist) on the concentrations of catecholamines in the adrenal vein were evaluated during the electrical stimulation of the adrenal nerve (5 V pulses of 2 ms duration for 3 min) at 3 Hz. Moreover, the effects of the systemic injections of more specific alpha 2-agonist and antagonist (oxymetazoline and idazoxan) were tested on the release of catecholamines in the adrenal vein in response to electrical stimulation of the splanchnic nerve at 1 and 3 Hz frequencies. The injection of 0.5 mg/kg of yohimbine caused a significant increase in the concentrations of epinephrine and norepinephrine in the adrenal vein induced by the electrical stimulation of the adrenal nerve and the injection of 15 micrograms/kg of clonidine had no effects.(ABSTRACT TRUNCATED AT 250 WORDS)

Adrenal Medulla↗