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Biomedical subjects

T Simmons

Publications and source records attributed to T Simmons.

9 recordsLinked to original sources
PubMed1992

Effect of atrioventricular synchrony on stroke volume during ventricular tachycardia in man.

The hemodynamic consequences of atrioventricular (AV) synchrony during ventricular tachycardia were evaluated during cardiac electrophysiologic testing. The relationship between stroke volume and the AV interval was investigated on a beat-by-beat basis in six patients during induced monomorphic ventricular tachycardia. Stroke volume was calculated either (1) in the right ventricle using impedance catheter method (four patients) or (2) in the left ventricle using Doppler measurement of aortic blood velocity (two patients). The impedance catheter method underestimated stroke volume by a factor of 4.2 +/- 2.4 compared with the thermodilution cardiac output method. However, there was a highly linear relationship between both methods for computing stroke volume (r greater than 0.9). Five patients had complete AV dissociation during ventricular tachycardia, and different AV intervals spanned the entire tachycardia cycle lengths. Largest stroke volumes were associated with optimal AV intervals within 120 and 230 msec, resulting in a 97 +/- 59% increase in stroke volume over ventricular tachycardia cycles not associated with atrial activity. Customized atrial pacing during ventricular tachycardia may provide a valuable means for artificially establishing the hemodynamically optimal AV interval and eliminating the ventricular tachycardia cycles not preceded by atrial activity.

Atrioventricular Node↗
PubMed1992

Pacing lead survival: performance of different models.

UNLABELLED: Recent reports have shown poor survival of some leads currently in use. Long-term survival analysis of 2,444 leads (1,059 atrial and 1,385 ventricular) implanted in this institution since January 1980, and having at least 1 month of follow-up was performed. The survival of 123 different models was compared with the average survival of all the leads implanted in the corresponding chamber. Failure was defined as inactivation of the lead (electrical abandonment, explant, or cap) due to insulator and/or conductor fracture. RESULTS: The mean follow-up was 33 +/- 32 months. The cumulative survival for different atrial lead models was consistent with the average performance in the atrium. No atrial lead showed better or worse survival compared to the others. In the ventricular group, the Medtronic 4012 lead showed statistically significant poorer survival (P = 0.01) compared with the average survival of the ventricular leads. The Cardiac Pacemakers, Inc. (CPI) 4010 lead showed a nonsignificant (P = 0.12) worse performance than the average for ventricular leads. CONCLUSIONS: (1) The Medtronic 4012 had a significantly poorer performance than the rest of the leads. A trend in similar direction was found for the CPI 4010, also in the ventricular group; (2) Atrial lead models showed a stable survival; and (3) Frequent follow-up is required for some leads, especially in pacemaker dependent patients.

Actuarial Analysis↗
PubMed1991

Automatic implantable cardioverter-defibrillator implantation without thoracotomy using an endocardial and submuscular patch system.

The automatic cardioverter-defibrillator lead system is implanted by a thoracotomy procedure that may result in atelectasis, pleural effusion, cardiac tamponade and lengthy convalescence. A new defibrillator lead system that allows selection of different defibrillating current pathways is implanted without a thoracotomy. Ten patients requiring a cardioverter-defibrillator for recurrent sustained ventricular tachycardia (five patients) or aborted sudden cardiac death (five patients) were evaluated for implantation of this lead system. A lead configuration with a bidirectional defibrillating current pathway was implanted in nine patients. The defibrillation threshold with this lead configuration was 15 J in five patients, 20 J in three and 30 to 35 J in one patient. In the remaining patient the lead system had a 40 J defibrillation threshold and was not implanted. No perioperative complications occurred. Induced ventricular fibrillation was successfully terminated at the predischarge and intermediate follow-up (8 to 12 weeks) electrophysiologic studies. During the follow-up period, there were three deaths (one sudden, two due to heart failure) and two lead system failures (oversensing with inappropriate shocks in one patient and patch lead fracture in another). Implantation of the cardioverter-defibrillator lead system by a nonthoracotomy approach is feasible, has no significant perioperative complications and is well tolerated by patients. Effective defibrillation was demonstrated immediately as well as at intermediate follow-up study. The occurrence of patch lead fracture and oversensing requires improvement in the present (nonthoracotomy) lead system technology.

Cardiac Pacing, Artificial↗
PubMed1991

Clinical performance of the implantable cardioverter defibrillator: electrocardiographic documentation of 101 spontaneous discharges.

Records of 105 patients, who received an automatic implantable cardioverter defibrillator (AICD), were studied to investigate the causes of spontaneous AICD discharges and to correlate the symptoms with the arrhythmias triggering AICD discharges. During a follow-up period of 13 +/- 8 months, 46/105 (44%) patients had 566 spontaneous AICD discharges. A total of 101 discharges were documented with Holter monitoring in 23 patients. In this study group, there were 8 (8%) AICD discharges for 5 episodes of ventricular fibrillation, and 68 (67%) discharges for 63 episodes of sustained ventricular tachycardia. Patients lost consciousness in all episodes of ventricular fibrillation, but were symptomatic prior to only 36 (53%) discharges in ventricular tachycardia. Nonsustained ventricular tachycardia persisting for a period of 7.5 +/- 2 seconds resulted in 20 AICD discharges; patients were symptomatic prior to 13 (65%) discharges. Supraventricular tachycardias triggered three discharges. One patient had two spurious discharges during sinus rhythm. In conclusion, most of the spontaneous AICD discharges were appropriate for the detected rhythms, but only clinically appropriate for the management of arrhythmias in 75% of the cases. A significant portion of the patients with sustained or nonsustained ventricular tachycardias triggering AICD discharges were asymptomatic prior to discharge, which requires further assessment of the physiology of the arrhythmia as a component of the detection algorithm.

Electric Countershock↗
PubMed1990

The effects of percutaneous catheter ablation on preexisting permanent pacemakers.

STUDY OBJECTIVE: Determine the effect of percutaneous catheter ablation (CA) on permanent pacemakers. MEASUREMENTS AND RESULTS: Twenty-three patients who underwent CA at The Cleveland Clinic Foundation from September 1983 to January 1990, and had a previously implanted pacemaker were studied. Electrocardiographic data during the CA procedure and clinic data including pacemaker evaluations were analyzed. Fifty-two percent (12/23) of the pacemakers malfunctioned: five developed transient ventricular loss of capture; two undersensing; one oversensing; three could not be interrogated or programmed, and one did not respond to the magnet test. Four patients developed syncopal episodes and two severe dizziness after the procedure. All had their pacemakers replaced. In total, seven were explanted. Destructive analysis by the individual manufacturer identified pacemaker circuitry failure in five. Unipolar pacemakers and anodal ablation procedures had more frequent and severe malfunctions, but the difference was not statistically significant. CONCLUSIONS: Pacemaker malfunction is frequent during CA. It may be prevented by programming the pacemaker, when possible, to the nonfunctioning mode (000 mode). Temporarily disconnecting the pacemaker during ablation requires further evaluation as an alternative approach. Close follow-up can detect pacemaker malfunction and prevent complications.

Adult↗
PubMed1978

Uptake and early fate of metaphase chromosomes ingested by the Wi-L2 human lymphoid cell line.

Aspects of the ingestion and early intracellular fate of homologous. [3H]-thymidine-labeled chromosomes (donor) were studied in recipient Wi-L2 cells in the absence of reutilized radioactivity. As much as 67% of the cell-associated radioactivity was resistant to hydrolysis by DNase I after 4 h of incubation. Cell fractionation and electron microscope autoradiography indicated that chromosome uptake was rapid, into both cytoplasmic and nuclear fractions and was facilitator and dose dependent. Sedimentation analysis demonstrated that at 4 h donor DNA of approximate single-strand mol wt of 1--6 X 10(6), as compared to 6--12 X 10(6) for chromosomal DNA, was recoverable in cell fractions. By 6 h, a significant portion of the nucleus-associated donor DNA was converted into material of higher mol wt, although no evidence was found for integration into recipient DNA. Cytoplasmic donor DNA continued to be degraded. An average number of chromosome equivalents of nucleus-associated donor DNA to recipient cell nuclei of 1--4 was obtained and its relationship to the lower frequency of chromosome-mediated gene transfer is discussed.

Cells, Cultured↗
PubMed1975

Rectal diverticula.

Eight cases of rectal diverticula are discussed with reference to the etiological, clinical and radiological findings. Males predominated 3:1 and the average number of diverticula in each patient was 2. Diverticulosis of the remaining colon, especially the sigmoid segment, always accompanied rectal diverticula. The average diameter of rectal diverticula was larger than that of the colonic: 2.5 cm vs. 0.5-1.0 cm. Rectal diverticula may be confused with a carcinoma at endoscopy. Surgical treatment becomes necessary if the diverticulum progresses to abscess formation and perforation.

Aged↗
PubMedDate not supplied

Signal-averaged electrocardiography for detection of ventricular tachycardia using fast Fourier transform filtering on a standard ECG cart.

Signal-averaged electrocardiography has been advocated as a technique to predict the occurrence of ventricular tachycardia, especially in patients with ischemic heart disease. We studied a heterogeneous population of 77 patients referred for electrophysiologic testing using a recently developed fast Fourier transform filtering system available as part of a standard electrocardiography cart. The sensitivity, specificity, and positive predictive accuracy of this system were consistent with those previously determined using bidirectional Butterworth filters or finite impulse response filtering techniques. This new filtering approach in generation of signal-averaged ECG data for detection of ventricular tachycardia has promise but will require use in larger groups to establish its true clinical value.

Electrocardiography↗