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PubMed2006

Time trends in ectopic pregnancies in a Norwegian county 1970-2004--a population-based study.

BACKGROUND: The study objective was to estimate temporal trends in ectopic pregnancy in a well-defined population. METHODS: We identified patients with ectopic pregnancy in hospital discharge registries in Sør-Trøndelag County, Norway, 1970-2004, and retrieved data from medical records. We calculated age-specific ectopic pregnancy incidence, proportions of patients with first ectopic pregnancy/prior infertility treatment, incidence of ectopic pregnancy by birth cohort and age and ratio of ectopic pregnancy to live births (extrauterine ratio) by age and parity. RESULTS: Age-adjusted ectopic pregnancy incidence rates increased from 4.3 to 16.0 per 10 000 women-years over the period 1970-1974 to 1990-1994 and declined to 8.4 per 10 000 women-years in 2000-2004. Incidences were highest among women aged 25-34 years throughout the study period. We observed decreases in proportions of women with previous ectopic pregnancy and with prior infertility treatment after 1990-1994. Incidence rates were the highest for women born between 1960 and 1964 in all age groups. Extrauterine ratio increased with age and was higher for women with two or more previous births compared with women with none or one prior birth. CONCLUSIONS: The epidemic increase in ectopic pregnancy towards 1990-1994 was followed by a marked decrease.

Adolescent↗
PubMed2006

Ectopic pregnancy risk with assisted reproductive technology procedures.

OBJECTIVE: To assess the ectopic pregnancy risk among women who conceived with assisted reproductive technology (ART) procedures. METHODS: The ectopic rate for ART pregnancies was calculated from population-based data of pregnancies conceived with ART in U.S. clinics in 1999-2001. Variation in ectopic risk by patient and ART treatment factors was assessed by using bivariate analyses and multivariable logistic regression. RESULTS: Of 94,118 ART pregnancies, 2,009 (2.1%) were ectopic. Variation was observed by procedure type. In comparison with the ectopic rate (2.2%) among pregnancies conceived with in vitro fertilization and transcervical transfer of freshly fertilized embryos from the patient's oocytes (fresh, nondonor IVF-ET), the ectopic rate was significantly increased when zygote intrafallopian transfer (ZIFT) was used (3.6%) and significantly decreased when donor oocytes were used (1.4%) or when a gestational surrogate carried the pregnancy (0.9%). Among fresh nondonor IVF-ET procedures, the risk for ectopic pregnancy was increased among women with tubal factor infertility (odds ratio [OR] 2.0, 95% confidence interval [CI] 1.7-2.4; referent group = ART for male factor), endometriosis (OR 1.3, 95% CI 1.0-1.6), and other nontubal female factors of infertility (OR 1.4, 95% CI 1.2-1.6) and decreased among women with a previous live birth (OR 0.6, 95% CI 0.5-0.7). Transfer of embryos with an indication of high implantation potential was associated with a decreased ectopic risk when 2 or fewer embryos were transferred (OR 0.7, 95% CI 0.5-0.9), but not when 3 or more embryos were transferred. CONCLUSION: Ectopic risk among ART pregnancies varied according to ART procedure type, reproductive health characteristics of the woman carrying the pregnancy, and estimated embryo implantation potential. LEVEL OF EVIDENCE: II-2.

Female↗
PubMed2003

Beta-human chorionic gonadotropin levels and the likelihood of ectopic pregnancy in emergency department patients with abdominal pain or vaginal bleeding.

UNLABELLED: Strategies for diagnosing ectopic pregnancy that defer endovaginal ultrasound in women with suggestive symptoms and serum beta-human chorionic gonadotropin (beta-hCG) levels less than 1500 mIU/mL ignore the increased risk of ectopic pregnancy in these patients. OBJECTIVE: To quantify this increased risk by establishing and comparing the beta-hCG distributions of symptomatic women with ectopic pregnancies, abnormal intrauterine pregnancies, and normal intrauterine pregnancies. METHODS: The authors reviewed the records of a cohort of women who visited an urban emergency department (ED) during a 34-month period with abdominal pain or vaginal bleeding and non-zero quantitative beta-hCG levels. Explicit criteria were used to determine whether the pregnancy ultimately turned out to be intrauterine and normal, intrauterine and abnormal, or ectopic. Probability distributions were compared using frequency distributions, receiver operating characteristic (ROC) curves, and likelihood ratios. RESULTS: Of 730 ED patients included in the analysis, 96 (13%) had ectopic pregnancies, 253 (35%) had abnormal intrauterine pregnancies, and 381 (52%) had normal intrauterine pregnancies. The beta-hCG distributions of patients with ectopic pregnancies and abnormal intrauterine pregnancies were similar and much lower than the beta-hCG distribution of patients with normal intrauterine pregnancies. A beta-hCG level less than 1500 mIU/mL more than doubled the odds of ectopic pregnancy (likelihood ratio = 2.24). Of the 158 patients with beta-hCG below 1500 mIU/mL, 40 (25%; 95% confidence interval [CI] = 19% to 32%) had ectopic pregnancies, and only 25 (16%; CI = 11% to 22%) had normal intrauterine pregnancies. CONCLUSIONS: In women with pain or bleeding and serum beta-hCG levels less than 1500 mIU/mL, the risk of ectopic pregnancy is substantially increased, while the likelihood of normal intrauterine pregnancy is low.

Abdominal Pain↗
PubMed2004

A serum proteomics approach to the diagnosis of ectopic pregnancy.

An ectopic pregnancy (EP) occurs when implantation of the embryo occurs outside of the uterus. If left untreated, the developing fetus will continue to grow, leading to life-threatening consequences for the mother. A major difficulty with the diagnosis of ectopic pregnancy is that methods of detection are limited, and some, such as ultrasound, are not very reliable in the earliest days of gestation. Currently, no effective serum test exists to distinguish an ectopic pregnancy from a normal intrauterine pregnancy. The incidence of ectopic pregnancy is increasing and has doubled in the last 20 years. It is now the second most common cause of maternal death in the first trimester of pregnancy. To address this issue, we initiated a project to identify serum markers of ectopic pregnancy. The subjects for these studies presented at the Hospital of the University of Pennsylvania. We obtained over 140 serum samples from women with suspected ectopic pregnancy: women presenting with pain and/or bleeding in the first trimester of pregnancy. The approximate racial breakdown of the subjects is as follows: African American, 36%; Caucasian, 3%; Asian, 2%; Hispanic, 1%; unknown, 58%. Serum samples from 139 women (62 with ectopic pregnancy and 77 with a normal intrauterine pregnancy) were applied to WCX2 (weak ion exchange) protein chip surfaces and analyzed for serum markers using surface-enhanced laser desorption/ionization time-of-flight mass spectrometry (SELDI-TOF-MS). Several proteins in the 7500-18,000 Da mass range were identified that may discriminate an ectopic pregnancy from an intrauterine pregnancy. The most promising markers were analyzed using classification and regression tree analysis (CART) with and without clinical variables (serum hCG value, length of amenorrhea). Two different algorithms were developed that classify the patients on the basis of sensitivity (number of EPs who screen positive/# of EPs) or specificity (# of healthy patients who screen negative/# of healthy). Our current approach is to refine these two "rule sets" to segregate patients into three groups: those who need immediate intervention for a probable ectopic pregnancy, those who appear to have a normal pregnancy, and those who need further monitoring for diagnosis.

Biomarkers↗
PubMed1998

Risk of ectopic pregnancy and previous induced abortion.

OBJECTIVES: This study investigated the role of prior history of induced abortion in subsequent ectopic pregnancies. METHODS: Data from two French case-control studies were used to examine the effect of induced abortion on ectopic pregnancy risk. Case patients (n = 570) were women admitted for ectopic pregnancy during the study period; controls (n = 1385) were women who delivered in the same center. RESULTS: The analysis among women with no previous ectopic pregnancy showed that, after control for the main ectopic pregnancy risk factors, prior induced abortion was associated with an increased risk of ectopic pregnancy (odds ratio [OR] = 1.5, 95% confidence interval [CI] = 1.0, 2.0); there was a significant trend between number of previous induced abortions and ectopic pregnancy risk (ORs = 1.4 for 1 previous induced abortion and 1.9 for 2 or more). CONCLUSIONS: This study suggests that induced abortion may be a risk factor for ectopic pregnancy for women with no previous ectopic pregnancy, particularly in the case of women who have had several induced abortions.

Abortion, Induced↗
PubMed1997

Evaluation of induced abortion as a risk factor for ectopic pregnancy. A case-control study.

OBJECTIVE: To assess the risk of ectopic pregnancy after one or more induced abortions. DESIGN: Population-based case-control study. METHODS: We studied all women who had a histologically verified ectopic pregnancy in one Norwegian county between January 1, 1987, and December 31, 1990. We identified population-based control sets of women among participants in the second Norwegian fertility study (1988-1989). Gravida women 20-39 years of age, who were not using contraceptives and had become spontaneously pregnant, were eligible for analysis. The final analyses included 174 women with ectopic pregnancy, 115 pregnant control women and 227 nonpregnant control women. STATISTICAL METHODS: Chi-square test and unconditional logistic regression. RESULTS: Fifty-three (30.5%) of women with ectopic pregnancy, 18 (15.7%) of pregnant control women and 51 (22.5%) of nonpregnant control women had had one or more previous induced abortions. The adjusted odds ratio of ectopic pregnancy among women with one previous induced abortion was 1.3 (95% confidence interval; 0.9 to 1.8) and 1.2 (95% CI; 0.8 to 1.7) compared with pregnant and nonpregnant control women, respectively. Among women who had two or more induced abortions, the adjusted odds ratio of ectopic pregnancy was 0.2 (95% CI; 0.04 to 0.9) compared with pregnant control women and 1.8 (95% CI; 0.4 to 7.8) compared with nonpregnant control women. When we used the outcome of the most recent pregnancy, birth as reference, we found no association between an outcome of induced abortion and subsequent ectopic pregnancy regardless of whether the control women were pregnant. CONCLUSION: We found no association between induced abortion and subsequent ectopic pregnancy. Women who had induced abortions were characterized as having several other risk factors for ectopic pregnancy.

Abortion, Induced↗
PubMedDate not supplied

Serum creatine kinase is not a reliable indicator of ectopic pregnancy.

OBJECTIVE: It has been reported that elevation in creatine kinase may be used as an indicator of ectopic pregnancy as a consequence of trophoblast invasion of the smooth muscle layer of the Fallopian tube. In this study, we attempt to verify this observation and establish the sensitivity and positive predictive value of the test. METHODS: Serum creatine kinase (MM-fraction) was obtained from patients presenting with possible ectopic pregnancy prior to surgical intervention. Ectopic pregnancies were confirmed by laparoscopy. Noted was whether the gestation was ruptured or unruptured, its location in the tube, and estimated cross-sectional tubal distention. Controls consisted of patients with first-trimester pregnancies simulating ectopic pregnancy, i.e., patients having a positive pregnancy test, complicated by vaginal bleeding and/or abdominal pain. RESULTS: The distribution of creatine kinase values for both patients with ectopics versus control are positively skewed, with a mode of 10-19 U/L. The mean creatine kinase for ectopic pregnancies was 62.3 U/L, S.D. = 63.1 U/L. For controls, the mean creatine kinase = 40.8 U/L, S.D. = 30.1 U/L. The difference in these means is significant (p = 0.04), but weakly so. In addition, for ectopic gestations there was no significant difference in creatine kinase values with regard to degree of tubal distention, gestation location, or whether rupture had occurred, thereby limiting the clinical value of this test. CONCLUSIONS: Although the mean value of serum creatine kinase is statistically significantly higher in ectopic pregnancy relative to controls, the distribution curve for creatine kinase values for ectopics is broad, with much overlap with the control curve. Hence, the sensitivity and positive predictive value for this test is poor.

Biomarkers↗
PubMed2001

[Persistent ectopic pregnancy, report of seven cases].

OBJECTIVE: To investigate and evaluate the occurrence, diagnosis and treatment of persistent ectopic pregnancy. METHODS: 411 patients with ectopic pregnancy treated via laparoscopy or laparotomy between July 1995 and June 2000 were reviewed. The clinic manifestations of patients who were successfully treated by laparoscopic surgery and those with persistent ectopic pregnancy were analyzed by multivariate stepwise logistic regression. RESULTS: Seven cases with persistent ectopic pregnancy occurred after laparoscopic surgery with an incidence rate of 3.5%. Six cases had been treated by conservative approach and one case by tubectomy. Persistent ectopic pregnancy was diagnosed in two cases because of abdominal pain and intra-abdominal hemorrhage and in five cases because of plateauing beta-hCG titers. Two of the seven cases underwent a second time laparoscopic surgery and five were treated with methotrexate. The size of ectopic mass and the absence of villi by pathologic finding were relevant factors of persistent ectopic pregnancy. CONCLUSION: Small mass of ectopic pregnancy, short amenorrhea time, and biopsy specimens in which no villi are found are all warning indicators of persistent ectopic pregnancy. Close postoperative beta-hCG surveillance is critical for diagnosis and treatment.

Chorionic Gonadotropin, beta Subunit, Human↗
PubMed2003

Improved fertility following conservative surgical treatment of ectopic pregnancy.

OBJECTIVE: To evaluate fertility after salpingectomy or tubotomy for ectopic pregnancy. DESIGN: Retrospective cohort study. SETTING: Clinical University Center, Hvidovre Hospital, Copenhagen. POPULATION: Two hundred and seventy-six women undergoing salpingectomy or tubotomy for their first ectopic pregnancy between January 1992 and January 1999 and who actively attempted to conceive were followed for a minimum of 18 months. METHODS: Retrospective cohort study combined with questionnaire to compare reproductive outcome following salpingectomy or tubotomy for ectopic pregnancy. Cumulative probabilities of pregnancy for each group were calculated by the Kaplan-Meier estimator and compared by Cox regression analysis to control for potential confounders. MAIN OUTCOME MEASURES: Intrauterine pregnancy rates and recurrence rates of ectopic pregnancy after surgery for ectopic pregnancy. RESULTS: The cumulative intrauterine pregnancy rate was significantly higher after tubotomy (88%) than after salpingectomy (66%) (log rank P < 0.05) after correction for confounding factors. No difference was found in the recurrence rate of ectopic pregnancy between the treatments (16% vs 17%). In patients with contralateral tubal pathology, the chance of pregnancy was poor (hazard ratio 0.463) and the risk of recurrence was high (hazard ratio 2.25), assessed with Cox regression. The rate of persistent ectopic pregnancy was 8%. CONCLUSION: Conservative surgery is superior to radical surgery at preserving fertility. Conservative surgery is not followed by an increased risk of repeat ectopic pregnancy, but by the risk of persistent ectopic pregnancy, which should be taken into account when deciding on the operative procedure. Management in case of contralateral tubal pathology is disputed and should ideally be addressed in a randomised clinical trial.

Adult↗
PubMed1990

Persistent ectopic pregnancy following laparoscopic linear salpingostomy.

As the surgical approach for ectopic pregnancies evolves from radical to conservative procedures, the potential hazard of persistent ectopic pregnancy has become increasingly pertinent. From September 1, 1986 to August 31, 1989, 11 women with persistent ectopic pregnancy after laparoscopic salpingostomy were diagnosed and treated at Yale-New Haven Hospital. Persistent ectopic pregnancy was suspected in nine cases because of symptoms and in two because of plateauing beta-hCG titers. Ten of 11 patients underwent repeat surgery. Eight had partial or complete salpingectomy of the involved ipsilateral tube, two had repeat salpingostomies, and one was treated with methotrexate. When the 11 women with persistent ectopic pregnancies were compared with 70 patients treated successfully by laparoscopic salpingostomy using multivariate stepwise logistic regression, smaller size of the ectopic (P less than .01) and fewer days of amenorrhea (P less than .05) predicted persistent ectopic pregnancy after laparoscopic salpingostomy. Based upon our experience, we believe that earlier-treated ectopic pregnancies (ie, fewer than 42 days of amenorrhea) and/or smaller ectopics (ie, 2.0 cm or less in diameter) require treatment with particular caution and close postoperative surveillance.

Chorionic Gonadotropin↗
PubMed1985

A multinational case-control study of ectopic pregnancy. The World Health Organization's Special Programme of Research, Development and Research Training in Human Reproduction: Task Force on Intrauterine Devices for Fertility Regulation.

We conducted a multinational case-control study of ectopic pregnancy in which 1108 ectopic cases were matched by age, parity and marital status with an equal number of pregnant and non-pregnant controls. When cases were compared to pregnant controls there was an increased relative risk (RR) of ectopic pregnancy associated with the use of an intrauterine device (IUD; RR = 6.4) and sterilisation (RR = 10.9) at time of conception, but there was no increased risk associated with oral contraception or other reversible methods. There was an excess of ovarian pregnancies among cases wearing an IUD, and more cases than controls using an IUD had evidence of pelvic inflammatory disease (PID). This suggests that the IUD increases the risk of ectopic gestation possibly by providing greater protection against intrauterine (rather than extrauterine) pregnancy, and by predisposing women to PID and tubal damage. When cases were compared to non-pregnant controls the relative risk of ectopic pregnancy was reduced with all methods, but this protective effect was less marked with the IUD (RR = 0.5) than with the pill (RR = 0.1), other interval methods (RR = 0.2) or sterilisation (RR = 0.2). IUD use prior to conception did not affect the risk of ectopic gestation (RR = 0.7). A past history of PID or sexually transmitted disease (STD) was associated with an increased risk of ectopic pregnancy compared to pregnant (RR = 2.8) and non-pregnant (RR = 2.0) controls. This risk may be higher with multiple episodes of previous PID, but the results were not consistent. Prior PID in the presence of an IUD did not increase the risk over and above that associated with a high risk of recurrence (RR = 7.0 for pregnant and RR = 9.3 for non-pregnant controls). Induced abortion did not significantly affect the risk of ectopic gestation, but spontaneous abortion was associated with an increased risk compared to non-pregnant controls. This finding may have been due to selection bias. Cigarette smoking was associated with an increased relative risk of 3.1 for pregnant and 1.8 for non-pregnant controls. This was not consistent in all comparison groups and may have resulted from confounding, but requires further investigation. We did not observe a significant risk of ectopic pregnancy following gynaecological surgery.

Contraception↗
PubMed1983

Ectopic pregnancy.

Ectopic pregnancy remains a significant contributor to maternal mortality and morbidity. Despite the obstetrician's awareness of the problems, ectopic pregnancy in many cases still remains a difficult diagnosis. Over the last 10 to 15 years diagnostic ultrasound has become an established means of supplying additional and occasionally diagnostic information on those patients suspected of having an ectopic pregnancy. In essence diagnostic ultrasound can provide information regarding the presence of an intra-uterine pregnancy, a finding which goes a long way to excluding an extra-uterine pregnancy, and can show that there is no gestation sac within the uterus, a finding which raises the level of suspicion of an ectopic pregnancy. In addition to these primary uses, diagnostic ultrasound can also provide information relating to the presence or absence of both an adnexal mass and free fluid in the pouch of Douglas. All of these features, however, are open to error and their appreciation leads to a more rational approach to the interpretation of the overall ultrasound findings. In using diagnostic ultrasound in at-risk patients, side-room urinary pregnancy tests, and if necessary the more sophisticated radioimmunoassays of beta-subunit hCG, should be used in conjunction. From the authors' own studies it was concluded that an empty uterus with an adnexal mass and/or the presence of free fluid in the pelvis, together with positive biochemistry, was able to give a very high level of diagnostic accuracy for ectopic pregnancy (95 per cent). However, an empty uterus alone in the absence of an adnexal mass or free fluid in the pelvis was not of itself a reliable guide to the presence of an ectopic pregnancy even in the presence of positive biochemistry. The finding of a living fetus outside the uterus was an uncommon event (6 per cent), but if present allows an absolute diagnosis of ectopic pregnancy. Finally a negative serum hCG assay virtually excludes the possibility of an ectopic pregnancy. A scheme involving the use of urine pregnancy testing, serum hCG assays and ultrasound has been proposed for the rational management of patients suspected of having an ectopic pregnancy and whose condition is stable. In all circumstances, however, it is stressed that should the patient's condition so warrant then surgical intervention is mandatory irrespective of the ancillary findings.

Adnexa Uteri↗
PubMed1980

beta-hCG as a diagnostic aid for suspected ectopic pregnancy.

During 13 months from November 1, 1977, through November 30, 1978, 283 patients underwent radioimmunoassay (RIA) for determination of serum beta-subunit of human chorionic gonadotropin (beta-hCG) to rule out ectopic pregnancy. The records of 234 patients were available for statistical analysis and of these, 188 (80%) had negative results, defined as less than 1 ng/ml. The ectopic group comprised 22 patients, all of whom had elevated beta-hCG levels. There were no false-negative results in either group. Patients with suspected ectopic pregnancy had symptoms similar to patients previously reported in the literature with proved ectopic pregnancies. The most common presenting symptoms of those with suspected ectopic pregnancy were abdominal pain (91%), amenorrhea (76%), irregular bleeding (68%), and andexal mass (55%). Seventy-three patients presented with the classic triad of pain, uterine bleeding, and adnexal mass. Only 10 (14%) had ectopic pregnancies. Urine pregnancy tests were found to be of no benefit in diagnosing ectopic pregnancy and confused the clinicians in some instances. In patients with suspected ectopic pregnancy, a negative beta-hCG, by the RIA technique ruled out ectopic pregnancy in 100% of the cases.

Adolescent↗
PubMed1994

Ectopic eruption of the maxillary first permanent molar. An epidemiological, familial, aetiological and longitudinal clinical study.

The aims of this thesis were to investigate the prevalence, familial tendency and aetiological factors of ectopic eruption of the maxillary first permanent molar, to analyse associations between ectopic eruption of the maxillary first permanent molar, to analyse associations between ectopic eruption of the maxillary first permanent molar and other tooth and developmental disturbances and cleft lip and/or palate defects, to make a longitudinal evaluation of the effects of orthodontic treatment in irreversible cases and of the prognosis for the atypically resorbed second primary molars in cases of reversible ectopic eruption and to carry out histological studies of second primary molars with extensive resorptions. The thesis is based on eight investigations. The subjects for the prevalence study consisted of 2,903 children. The main subjects in the clinical studies were the children with ectopic eruption of the maxillary first permanent molar from those children. The methods used were radiographic assessments, biometrics, orthodontic treatment, histology, different statistical methods and clinical assessments. The prevalence of ectopic eruption of the maxillary first permanent molar was found to be 4.3 per cent for the population and 21.8 per cent for cleft children. In sibs to children with ectopic eruption the prevalence was 19.8 per cent, indicating a genetic background. The main aetiological factors were the greater mesial angulation and the greater width of the ectopically erupted first permanent molar. In cases of reversible ectopic eruption the atypically resorbed second primary molars remained to the normal exfoliation time in 90 teeth out of 92. Treatment with cervical headgear in 46 children for an average of 9 months resulted in uprighting of the upper first permanent molars to good occlusion and in about 70 per cent of the children sufficient space for the second premolars. In the long-term follow-up, 10 years after treatment, two forms of discriminant analysis were used to evaluate the long-term treatment effects. The analyses showed a uniformity of the cases, indicating that the effects of the eruption disturbance had been corrected and all negative side effects of the treatment were eliminated.

Adolescent↗
PubMed1997

[Intervention approach and its effect on lowering mortality of ectopic pregnancy in Shanghai].

OBJECTIVE: To explore an effective intervention approach to lower the mortality of ectopic pregnancy. METHODS: We monitored the mortality of ectopic pregnancy during 1987-1995 in Shanghai and experts' audit, focusing on the causes of death from ectopic pregnancy and combining official administration with intervention approach in medical institutions. RESULTS: Misdiagnosis and patient's delay to hospital were the causes of death from ectopic pregnancy. There were 523,299 live births in Shanghai from 1987 to 1989, in which 23 cases died from ectopic pregnancy, with a mortality of 4.40/100,000. After implementing the intervention approach, during 1990-1995, 14 cases of the total 625,206 nancies live birth died from ectopic pregnancy, with a mortality of 2.24/100,000, as compared the two, P < 0.05. Accordingly, ectopic pregnancy as the cause of maternal death dropped from the first leading cause to the fourth. CONCLUSION: Intensive health care education in masses, medical staffs' awareness to ectopic pregnancy, and intervention, early hospitalization, early diagnosis and early therapy can lower the mortality of ectopic pregnancy.

Adult↗
PubMed1981

Diuretic-induced ventricular ectopic activity.

The need to avoid hypokalemia during diuretic therapy in nondigitalized patients has been questioned. Twenty-one patients with (1) mild essential hypertension, (2) plasma potassium of less than 3.5 meq/liter during previous diuretic treatment, and (3) normal findings [less than 6 unifocal ventricular premature beats/hour] on 24-hour ambulatory electrocardiographic monitoring and exercise testing were treated with hydrochlorothiazide (50 mg twice a day) for four weeks and then ambulatory electrocardiographic monitoring and exercise testing were repeated. Ambulatory electrocardiographic monitoring revealed that ventricular ectopic activity developed in seven patients and complex ventricular ectopic activity (multifocal ventricular premature beats, ventricular couplets and/or ventricular tachycardia) in four. Only two of these seven had ventricular ectopic activity during exercise testing while they were hypokalemic. Potassium repletion in these seven patients with spironolactone abolished complex ventricular ectopic activity and reduced unifocal ventricular premature beats significantly (p less than 0.01) from an average of 71.2 ventricular premature beats/hour/patient during hydrochlorothiazide treatment to 5.4 ventricular premature beats/hour/patient after potassium repletion. Although complex ventricular ectopic activity was more likely to occur with plasma potassium less than 3.0 meq/liter, restoration of normokalemia was required in several patients to abolish residual ventricular ectopic activity. Persistent ventricular ectopic activity in one patient suggested that myocardial injury sustained during hypokalemia may initiate chronic ventricular ectopic activity. Even in nondigitalized patients, the hazard of diuretic-induced ventricular ectopic activity warrants correction of hypokalemia.

Adult↗
PubMed2005

Ectopic discharges from injured nerve fibers are highly correlated with tactile allodynia only in early, but not late, stage in rats with spinal nerve ligation.

It is widely accepted that ectopic discharges originated from injured sites and dorsal root ganglion (DRG) neurons after peripheral nerve injury contribute to neuropathic pain. However, it has been recently shown that ectopic discharges were not always necessary for neuropathic pain. In the present study, we aim to further examine the role of ectopic discharges in neuropathic pain in a spinal nerve ligation (SNL) model. With teased fiber recordings in vivo, the characteristics of ectopic discharges were observed over 14 days after SNL, and the correlation between ectopic discharges and tactile allodynia was analyzed. It was observed that ectopic discharges have three firing patterns (tonic, bursting, and irregular) after SNL, and proportions of these three patterns changed dynamically over time. The tonic and bursting types were dominant in the first 24 h following SNL, while the irregular type became the only pattern in the late stage (day 14). The average frequencies of ectopic discharges and the percentage of active filaments also changed over time, reaching the peak 24 h after SNL and then declined gradually. Ectopic discharges were highly correlated with tactile allodynia in the first 24 h following SNL, but surprisingly, not in the late stage of days 1 to 14. These findings suggest that ectopic discharges may be crucial in the triggering of neuropathic pain in the early stage, but their importance become more limited over time.

Action Potentials↗
PubMed1999

Changes in sinus RR interval patterns preceding ventricular ectopic beats: assessment with rate enhancement and dynamic heart rate trends.

Changes in heart rate preceding ventricular ectopic beats may be used to identify clinical subsets of patients. We evaluated RR interval patterns preceding ventricular ectopic beats with a rate enhancement method which estimates ventricular ectopic beat dependence on the sinus RR interval preceding the ventricular ectopic beat and the dynamic heart rate trend, which is based on the slope of the five RR intervals preceding the ventricular ectopic beat. Using these two methodologies in 176 patients with frequent ventricular ectopic beats we identified several unique subsets of patients: (1) bradycardia-enhanced patients were younger with a high proportion of males and longer, more variable coupling intervals; (2) tachycardia-enhanced patients exhibited sleep suppression of ventricular ectopic beats and had shorter, less variable coupling intervals; (3) patients with predominantly no change in RR preceding the ventricular ectopic beat were significantly older, with greater prevalence of cardiovascular disease and reduced sinus RR variability, indicating decreased autonomic nervous system activity. These two methods may serve as a basis for further investigations regarding the treatment and prognosis of ventricular ectopic beats.

Age Factors↗