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Biomedical subjects

S Furman

Publications and source records attributed to S Furman.

At least 145 records · Page 8Linked to original sources
PubMed1988

Survival of patients with the automatic implantable cardioverter defibrillator.

Between May 1982 and May 1988, 37 patients (28 males and 9 females, mean age 57.6, range 16-76 years) of approximately 600 evaluated for sustained ventricular tachycardia and/or fibrillation (VT/VF) were treated with an automatic implantable cardioverter defibrillator (AICD). Twenty-eight of the patients had coronary artery disease, 7 had nonischemic cardiomyopathy, 1 had amyloid heart disease, and 1 had rheumatic heart disease. The mean ejection fraction was 32.2 +/- 12.9% (range, 9-64%). Eleven patients have died at a mean of 16.7 months after implantation. The cumulative survival rate was 81% at 1 year, 77% at 2 years, 68% at 3 years, and 53% at 4, 5, and 6 years. Considering only sudden deaths, the survival was 97% at 1 and 2 years, 90% at 3 years, and 80% at 4, 5, and 6 years. Twenty-one of the 37 patients received spontaneous shocks. If the first shock marks the time to death in the absence of an AICD, the cumulative survival rate would have been 56% at 1 year, 42% at 2 years, 29% at 3 years, and 14% at 4, 5, and 6 years. The maximum amount of time to a first appropriate shock was 39.7 months. Thirty-nine devices have been explanted: 28 for battery depletion; 5 for infections; 3 for improper sensing; 2 for electronic failure; and 1 at the time of cardiac transplantation. The average time to failure of the 28 units removed for battery depletion was 19.8 +/- 6.9 months.(ABSTRACT TRUNCATED AT 250 WORDS)

Actuarial Analysis↗
PubMed1988

Protective effects of vitamins E and C on erythrocytes in blood preserved in ACD solution and stored at 4 degrees C.

Vitamins E and C were used for the enrichment of the fluid for blood preservation. Whole blood with added ACD solution and vitamins E and C was stored at 4 degrees C for 21 days. The performed determinations included: haematocrit, osmotic fragility of the erythrocytes, ATP and 2,3-DPG content in the erythrocytes, and echinocyte count. A protective effect of these vitamins on erythrocytes was manifested by the decreased osmotic fragility, the steep fall of 2,3-DPG compared with the blood preserved in the vitamin-free ACD solution.

2,3-Diphosphoglycerate↗
PubMed1987

Long-term efficacy of antitachycardia pacing for supraventricular and ventricular tachycardias.

Over a 14-year period, 53 patients received implanted pacemakers to assist in the control of recurrent tachycardias. Indications were: prevention of tachycardia in 2 patients with supraventricular tachycardia (SVT), and 4 with ventricular tachycardia (VT); termination of tachycardia (15 SVT, 20 VT); and long-term periodic programmed electrical stimulation with potential for tachycardia termination (12 VT). Pacemakers for prevention of VT were implanted in 3 patients with prolonged QT interval syndromes and 1 in whom Holter monitoring showed a significant reduction in ectopic activity during pacing. Pacers were implanted for tachycardia termination only after patients underwent a rigorous protocol aimed at achieving 100 trials of the proposed modality. Patients with tachycardia also requiring antibradycardia pacemakers received pacemakers capable of noninvasive programmed stimulation for use during follow-up. There were no tachycardia recurrences among those patients in whom pacemakers were implanted for prevention. Pacers capable of outpatient programmed stimulation were useful, and it may be desirable to expand their use. The 15 patients with pacers designed for termination of SVT were followed for a mean of 68 months. Among these, actuarial continuation of pacing efficacy was 93% at 1 year, and 78% at 5 years. The 20 patients with pacers for termination of VT were followed for a mean of 37 months. Actuarial efficacy was 78% at 1 year, and 55% at 5 years. Sudden death occurred in 4 of these patients, none clearly pacer related. Pacemakers can play a major therapeutic role in some patients with recurrent tachycardias. The role of such pacemakers in patients with VT may be expanded with the advent of combined pacer-defibrillators.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1987

Automatic implantable cardioverter-defibrillator: patient survival, battery longevity and shock delivery analysis.

The automatic implantable cardioverter-defibrillator (AICD) has been shown to reduce the mortality rate of patients with malignant ventricular tachyarrhythmias. This report describes experience with implantation of 36 automatic implantable cardioverter-defibrillators (AID-B and AID-BR models) in 22 persons over a 44 month patient follow-up period (mean 19.6 months). There were five deaths: two patients died suddenly 22 and 29 months, respectively, after their second implant, one died of congestive heart failure, one died of respiratory failure and one died of catheter sepsis. Although 11 (50%) of the 22 patients never received a countershock for a ventricular tachyarrhythmia and are still alive, the other 11 received one or more spontaneous countershocks. Nine patients (41%) experienced spurious shocks during the follow-up period. Assuming that the first shock for presumed ventricular tachyarrhythmia prevented death, the hypothetical cumulative survival of patients at 42 months would have been 34 +/- 14.1% in the absence of an automatic implantable cardioverter defibrillator rather than the actual survival rate of 59 +/- 16.8%. The cumulative device survival of the 36 AID-B units was 92 +/- 5.62% at 15 months but diminished to 37 +/- 14.4% by 20 months. No unit lasted longer than 22 months. There were 12 battery depletions. The number of shocks emitted did not influence unit longevity. The manufacturer's elective replacement indicator is of uncertain validity. Six units remained active 7 to 17 months after surpassing their replacement indicator. The automatic implantable cardioverter-defibrillator prolongs the life of many patients with otherwise intractable arrhythmias.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1987

Automatic implantable cardioverter/defibrillator: inadvertent discharges during permanent pacemaker magnet tests.

A patient with an automatic implantable cardioverter defibrillator (AICD) received two inadvertent shocks when a magnet was placed over the pacer during a routine permanent pacer check. Analysis of the rhythm strip suggested that both patients' QRS complexes (133 beats/minute) and asynchronous pacer artifacts (70 beats/minute) were counted by the AICD sensing system and exceeded the rate criteria of 153 beats/minute. This resulted in shocks from the AICD during sinus rhythm at 133 beats/minute. To avoid possible inadvertent shocks, an AICD should be deactivated while a magnet is placed over the pacemaker during a permanent pacer check.

Electric Countershock↗
PubMed1987

Comparison of myopotential interference in unipolar-bipolar programmable DDD pacemakers.

Myopotential interference (MPI) can inhibit or trigger single and dual chamber unipolar pacemakers while bipolar pacemakers are resistant. Twenty units of two different models of dual chamber pacemaker, each capable of being programmed to single chamber or dual chamber and unipolar or bipolar function were tested to provoke myopotential interference. No patient had evidence of myopotential interference at any sensitivity setting in the bipolar configuration either in atrium or in ventricle. All patients (20/20) interfered with pacemaker function at the highest atrial or ventricular sensitivity settings in the unipolar configuration. T wave sensing occurred at the 0.25 mV sensitivity setting in four patients in pacemaker model 925, in both bipolar and unipolar configurations. Twenty-five percent of patients had myopotential interference at the unipolar atrial sensing threshold and did not allow a setting which would reject myopotential interference while providing satisfactory atrial sensing. Twenty percent (2/10) had myopotential caused ventricular inhibition at the least sensitive ventricular channel setting in model 240G so that myopotential interference could not be avoided in that unit no matter how large the electrogram.

Arrhythmias, Cardiac↗
PubMed1987

NASPExAM.

Explore the source record for details and available documents.

Cardiac Pacing, Artificial↗
PubMed1987

Performance of implantable cardiac rhythm management devices.

Our data represent use, follow-up, and management decisions from seven independently functioning centers and most importantly, actuarial survival of ICRMDs that have been implanted for sufficient time period to allow assessment of time versus failure. General patterns of possible target durations for adequate performance for present or future generations of similar clinical devices may be suggested by the data that we have presented. However, it would be inappropriate to conclude from these data that any presently implanted ICRMD would have a particular functional reliability. These data, furthermore, only summarized device hardware performance and cannot and must not be used to determine either short-term or long-term individual patient status, management, or outcome.

Actuarial Analysis↗
PubMed1987

Retained pacemaker leads.

Increasingly, functionless pacemaker leads are being abandoned in place because they cannot be safely removed. One hundred eighty-nine intact or partially removed pacemaker leads were abandoned in situ in 152 patients between Jan. 1, 1965, and Dec. 31, 1985. The leads, sometimes several leads in a single patient, were deemed uninfected at the time of abandonment in 137 patients and contaminated with Staphylococcus epidermidis in 15 patients. All of the contaminated leads have remained clinically uninfected during follow-up. One clean lead became infected early after implantation and the patient died after an open cardiac operation to remove that lead and an adjacent abandoned lead that was adherent to the subclavian vein. No other patient has had a late complication during follow-up to 256 months (mean 47.6). Properly managed abandonment of an uninfected lead can carry a very low complication rate.

Electrodes, Implanted↗
PubMed1986

Sports injuries and family practice--who do roadrunners consult?

A survey among roadrunners revealed that 58.9% had suffered a sports injury in the previous year; 13% did not seek medical help, 24% elected to see their general practitioner, and 64% chose other health professionals as their initial contact. The reasons given by those who elected not to see their general practitioner are presented.

Athletic Injuries↗
PubMed1986

Discrimination of antegrade and retrograde atrial depolarization by electrogram analysis.

The inability of cardiac pacemakers to selectively reject retrograde P waves limits the usefulness of dual-chamber pacemakers (because of the possibility of endless loop tachycardias) and of antitachycardia devices which use a dual-chamber sensing algorithm. In order to determine selective sensing parameters, amplitude, slew rate, and configuration of antegrade and retrograde atrial electrograms were measured in 34 patients undergoing dual-chamber pacemaker implant--31 with unipolar and three with bipolar units. All antegrade and retrograde pairs were measurably different. All 34 cases had measurable antegrade/retrograde amplitude differences; 30 of the unipolar cases (96.8%) and all bipolar cases displayed antegrade/retrograde amplitude differences of at least 0.25 mV. Thirty of the unipolar cases (96.8%) and two bipolar cases had measurable slew rate differences. Configuration differed in 14 of 31 (45.2%) of unipolar and in two bipolar cases. A combined criterion with 0.25 mV sensitivity steps (available in at least two presently available pacemakers) and 0.5 V/sec slew rate gradations (through the use of externally programmable filters) would allow the discrimination of retrograde from antegrade depolarizations in all 34 cases. With the use of amplitude and slew rate differences, it is therefore possible to reject retrograde P waves while sensing antegrade P waves with current technology.

Cardiac Pacing, Artificial↗
PubMed1986

Venous cutdown for pacemaker implantation.

Two hundred sixty-eight dual-chamber pacemaker implants using polyurethane leads for atrium and ventricle were analyzed for the vein of entry for both atrial and ventricular leads. The cephalic vein was used for both leads in 61.2%, the external jugular vein for both leads in 8.6%, both veins in 7.8%, and the subclavian vein alone in 16.4%. The total for venous cutdown alone was 77.6%. There were no complications relevant to the vein of approach for the venous cutdown leads, but there was one pneumothorax requiring thoracic intubation for the subclavian puncture route. Venous cutdown is satisfactory for dual-chamber pacing requiring two lead systems.

Arm↗