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At least 163 records · Page 9Linked to original sources
PubMed2004

Effects of successive running and cycling on the release of atrial natriuretic factor in highly trained triathletes.

AIM: To evaluate the influence of successive running and cycling on both exercise-induced arterial hypoxemia (EIAH) and atrial natriuretic factor (ANF) release, 5 triathletes performed 2 separate exercise trials. METHODS: One trial consisted of a 20-min+20-min successive cycle-run exercise (C(1)-R(2)) and the other consisted of a 20-min+20-min successive run-cycle exercise (R(1)-C(2)). Arterial oxygenation (PaO(2)) and ANF were determined at pre-exercise, at the end of each 20-min segment of exercise and after 10 min of recovery. RESULTS: EIAH was noted during C(1)-R(2) and R(1)-C(2) trials. A higher EIAH was observed during running compared with cycling performed in the 1(st) position (R(1) vs C(1)) in the succession. In contrast, no difference was observed between successive running and successive cycling (R(2) vs C(2)), (-10.6+/-7.0 vs -15.6+/-4.0 mmHg for C(1)-R(2) and -20.9+/-6.0 vs -16.2+/-2.4 mmHg for R(1)-C(2)). ANF showed no difference between cycling and running performed in first position, whereas a significantly lower ANF was observed during successive cycling compared with successive running (C(2) vs R(2)) (19.9+/-3.72 vs 36.2+/-6.4 pmol.L(-1)). During recovery, neither PaO(2) nor ANF plasma returned to baseline level after either trial. CONCLUSION: This study provides new information on some of the physiological modifications that occur during multi-sports. Specifically, the impact of the modality of the successive exercise on ANF release and body fluid regulation was observed. Cycling as the successive exercise seems to cause lower ANF release than does running.

Adaptation, Physiological↗
PubMedDate not supplied

An assessment of the success of meperidine and promethazine sedation in medically compromised children.

A retrospective study evaluated the success of orally administered meperidine (1.0 mg/lb) and promethazine (0.5 mg/lb) combined with N20:02, and determined predictors of success in a medically, physically and/or mentally compromised population. Behavior of 143 uncooperative patients (mean age 6.4 years) was evaluated during 282 sedations. A simplified Success Index rated outcome: 1-failure, 2-moderately successful; 3-highly successful. Variables were examined for effect on outcome of sedation: physical and/or neurologic component of medical diagnosis; previous hospital experience; medication category. Children taking medications with CNS actions were significantly less likely to have either moderately successful (p = .008) or highly successful appointments (p = .002). Children with a neurologic component to their medical diagnosis were significantly less likely to have a highly successful appointment (p = .001). Oral sedation was effective for this population (77 percent were successful) and certain characteristics of the patient's condition can predict success.

Adolescent↗
PubMed1999

Vascularized bone flaps versus nonvascularized bone grafts for mandibular reconstruction: an outcome analysis of primary bony union and endosseous implant success.

BACKGROUND: Functional restoration following resection or traumatic injury to the mandible depends on the reliability of the bony reconstruction to heal primarily and support endosseous implants. Although vascularized bone flaps (VBF) and nonvascularized bone grafts (NVBG) are both widely used to reconstruct the mandible, indications for each remain ill-defined. The purpose of this study was to compare bone graft/flap healing and success of implant placement in patients reconstructed with VBF versus NVBG. METHODS: Over the past 10 years, 75 consecutive mandibular reconstructions were performed (26 free bone grafts, 49 vascularized bone flaps). Etiology of the defect, history of irradiation, bone defect size, number of operations, graft/flap success, and dental implant success rates were determined and compared. Bone graft/flap success was defined as complete bony union. Implant success was defined as complete osseointegration. Mean follow-up was 3 years. RESULTS: Free flaps were used primarily for malignant disease (78%, 38/49). Bone grafts were used primarily for benign disease (88%, 23/26). History of prior irradiation: 11% (3/26) NVBG versus 45% (22/49) VBF. Length of bony defect (mean): 8.1 cm NVBG versus 9.4 cm VBF. Successful bony union, any size defect: 69% (18/26) NVBG versus 96% (47/49) VBF (p < .0005); lateral defects only: 75% (15/20) NVBG versus 100% (17/17) VBF (p < .05). Number of operations to achieve bony union (mean), any size defect: 2.3 NVBG versus 1.1 VBF (p < .001); lateral defects only: 1.9 NVBG versus 1.0 VBF (p < .005). Twenty-two patients (29%) had a total of 104 endosseous implants placed (NVBG: 8 patients, 33 implants; VBF: 14 patients, 71 implants). Immediate implants placed: 0/33 NVBG versus 54% (38/71) VBF. Overall implant success: 82% (27/33) NVBG versus 99% (70/71) VBF (p < .0001). Implant success in VBF patients with a history of RT: 100% (15/15). CONCLUSIONS: Despite the fact that patients reconstructed with VBFs were older, had larger defects, and were treated primarily for malignant disease and therefore had a higher incidence of irradiation to the affected mandible than in patients treated with NVBGs, the incidence of bony union was higher, requiring fewer operations to achieve union, and the implant success rate was significantly greater than for NVBG patients. Results were similar when considering lateral defects only. Based on these results, VBFs are indicated in most cases of mandibular reconstruction; NVBGs are effective for short bone defects (<5-6 cm), in nonirradiated tissue, and/or in patients determined to be too medically compromised to tolerate the additional operative time required for a free-flap reconstruction.

Adolescent↗
PubMed2000

Predator avoidance, breeding experience and reproductive success in endangered cheetahs, Acinonyx jubatus.

I examine three hypotheses about predator avoidance behaviour: (1) avoidance increases an individual's reproductive success; (2) avoidance changes with breeding experience according to one of three described models; and (3) any reproductive or experience benefits accrued to individuals by avoidance are reflected in their spatial distribution. These hypotheses were tested on cheetahs which incur substantial juvenile mortality from predation by two larger competitors: spotted hyaenas, Crocuta crocuta, and lions, Panthera leo. To examine avoidance tactics, I played lion and hyaena vocalizations to individual female cheetahs. Lion avoidance increased with the statistical interaction between age and reproductive success, suggesting that it may be a learned behaviour, reinforced by successful reproductive events. This behaviour translated into a nonrandom spatial distribution of cheetahs with the most reproductively successful females found near lower lion densities than less successful females. Hyaena avoidance decreased with the interaction between age and reproductive success, suggesting that it is diminished by successful reproductive events, perhaps because a female cheetah switches from avoidance to using antipredator behaviours as she gets older. Hyaena avoidance behaviour translated into a spatial distribution with the most reproductively successful females found near lower hyaena densities than less successful females; however, younger females were found near lower hyaena densities than older females. Copyright 2000 The Association for the Study of Animal Behaviour.

Journal Article↗
PubMed1997

[Importance of endocardial ECG for successful AV-node modulation in patients with AV-node reentry tachycardia].

UNLABELLED: In 49 patients undergoing slow pathway (SP) ablation for AV nodal reentrant tachycardia (AVNRT) the local electrograms of successful and non-successful radiofrequency current applications taken from the mapping/ablation catheter in the posteroseptal space were retrospectively analyzed with respect to the following parameters: 1) ratio of local atrial (A) to local ventricular (V) electrogram amplitude (A/V-ratio), 2) presence of fractionated atrial activity (FAA) or SP potential (SPP), 3) duration of local A electrogram. Ablation sites were classified in 3 groups: group I: no FAA/SPP, A/V-ratio > or = 0.25; group 2: FAA/SPP or A/V-ratio < 0.25; group 3: FAA/SPP and A/V-ratio < 0.25. RESULTS: In all patients SP ablation was successful after 4.6 +/- 4.4 applications. Successful ablation sites had a significantly smaller A/V-ratio than non-successful ones (0.2 +/- 0.04 vs. 0.44 +/- 0.06, p = 0.023). The local A electrogram duration was not significantly different (72.3 +/- 2.14 vs. 71 +/- 1.35 ms, p = n. s.). CONCLUSIONS: 1) In SP ablation of AVNRT the local A/V-ratio is significantly smaller in successful compared to non-successful ablation sites. 2) Local A electrogram duration does not correlate with ablation success. 3) A local A/V-ratio of < 0.25 and the presence of a SPP or FAA are correlated with ablation success.

Adult↗
PubMed2007

Sacral nerve stimulation in fecal incontinence: are there factors associated with success?

PURPOSE: Sacral nerve stimulation has been used successfully in treating fecal incontinence. This study was designed to evaluate the proportion of patients with unsuccessful implantation despite positive test stimulation and to examine and compare factors associated with the success of the transitory and permanent sacral nerve stimulation. METHODS: A total of 61 patients (55 females; median age, 56 (range, 33-77) years) with refractory fecal incontinence underwent temporary stimulation. A 50 percent or greater improvement in the number of episodes of fecal incontinence or urgency was required to proceed to permanent implantation and was the criteria of success of permanent sacral nerve stimulation at the last follow-up visit in implanted patients. The factors compared between the success and the failure groups during temporary and permanent stimulation were patients' age and gender, diagnosis and characteristics of fecal incontinence, previous surgery, quality of life scores, anorectal manometry, endoanal ultrasound, and electrophysiologic tests performed before stimulation. RESULTS: Temporary stimulation was successful in 35 patients (57.4 percent). A permanent neurostimulation device was implanted in 33 patients. Age was the only factor related to success of the temporary stimulation (P=0.03). After permanent implantation, 31 percent of patients did not attain screening phase results for the number of episodes of fecal incontinence or urgency. A neurologic disorder was more frequently the origin of fecal incontinence in the success group compared with others (P=0.03). The left bulbocavernosus reflex was more frequently delayed in the success group than in the others (P=0.03), and a prolonged or absent bulbocavernosus reflex was more frequent in the success group than in the failure group (P=0.03). CONCLUSIONS: Patients with fecal incontinence from neurologic origins could be good candidates for sacral nerve stimulation.

Adult↗
PubMed2005

The MFMU Cesarean Registry: factors affecting the success of trial of labor after previous cesarean delivery.

OBJECTIVE: The purpose of this study was to determine which factors influence the likelihood of successful trial of labor (TOL) after 1 previous cesarean delivery (CD). STUDY DESIGN: We performed a multicenter 4-year prospective observational study (1999-2002) of all women with previous CD undergoing TOL. Women with term singleton pregnancies with 1 previous low transverse CD or unknown incision were included for analysis. RESULTS: Fourteen thousand five hundred twenty-nine women underwent TOL, with 10,690 (73.6%) achieving successful VBAC. Women with previous vaginal birth had an 86.6% success rate compared with 60.9% in women without such a history (odds ratio [OR] 4.2; 95% CI 3.8-4.5; P < .001). TOL success rates were affected by previous indication for CD, need for induction or augmentation, cervical dilation on admission, birth weight, race, and maternal body mass index. Multivariate logistic regression analysis identified as predictive of TOL success: previous vaginal delivery (OR 3.9; 95% CI 3.6-4.3), previous indication not being dystocia (CPD/FTP) (OR 1.7; 95% CI 1.5-1.8), spontaneous labor (OR 1.6; 95% CI 1.5-1.8), birth weight <4000 g (OR 2.0; 95% CI 1.8-2.3), and Caucasian race (OR 1.8, 95% CI 1.6-1.9) (all P < .001). The overall TOL success rate in obese women (BMI > or = 30) was lower (68.4%) than in nonobese women (79.6%) (P < .001), and when combined with induction and lack of previous vaginal delivery, successful VBAC occurred in only 44.2% of cases. CONCLUSION: Previous vaginal delivery including previous VBAC is the greatest predictor for successful TOL. Previous indication as dystocia, need for labor induction, or a maternal BMI > or = 30 significantly lowers success rates.

Adult↗
PubMed2004

Procedural success versus clinical risk status in determining discharge of patients after primary angioplasty for acute myocardial infarction.

OBJECTIVES: We evaluated whether patients' clinical status, angioplasty success, or both, should guide discharge after primary angioplasty (i.e., percutaneous coronary intervention [PCI]) for acute myocardial infarction (AMI). BACKGROUND: Current guidelines do not address a discharge strategy for AMI patients undergoing successful PCI. METHODS: Patients who underwent PCI in Primary Angioplasty in Myocardial Infarction (PAMI) studies (N = 3,188) were classified as "high clinical risk" if they had either age >70 years, Killip class >1, heart rate >100 beats/min, systolic blood pressure <100 mm Hg, anterior MI, or left bundle branch block, and as "low clinical risk" if none was present. Successful PCI patients were compared with those with unsuccessful PCI in both groups for 30-day major adverse cardiac events (MACE). RESULTS: Percutaneous coronary intervention was successful in 668 (90%) of 745 low-risk clinical and 2,104 (86%) of 2,443 high-risk clinical patients. Regardless of clinical risk status, patients with successful PCI had lower 30-day MACE than those with unsuccessful PCI (low-risk group: 4.6% vs. 22%, p < 0.0001; high-risk group: 7% vs. 21%; p < 0.0001). Moreover, successful PCI patients with either risk status had few MACE after day 4, whereas unsuccessful PCI patients had more MACE. The success of PCI was the strongest independent predictor of 30-day MACE (odds ratio [OR] 3.7, 95% confidence interval [CI] 2.8 to 5.0). A constellation of three or more high-risk clinical features also predicted higher 30-day MACE (OR 2.25, 95% CI 1.62 to 3.12). CONCLUSIONS: The success of PCI is the prime determinant of clinical outcome after PCI for AMI. The majority of AMI patients with less than three high-risk clinical features who undergo successful PCI may be discharged from the hospital by day 4. In contrast, patients with more than two high-risk clinical features or unsuccessful PCI may need longer observation.

Aged↗
PubMed1996

Determining the clinical efficacy and cost savings of successful external cephalic version.

OBJECTIVE: The aim of this study was to determine predictors of successful external cephalic version and to calculate the associated cost savings achieved with success. STUDY DESIGN: A retrospective study of 203 women with singleton gestations who underwent external cephalic version was performed. Descriptive, univariate, and multivariate analyses were performed on patient-specific risk data to predict successful version. National claims data were used for the cost simulation. RESULTS: Higher parity (p = 0.02), transverse-oblique presentation (p = 0.001), posterior placenta (p = 0.001), and a longer duration of pregnancy (p = 0.001) significantly increased the likelihood of a successful version. Heavier maternal weight was negatively associated with successful version (p = 0.05). The cost simulation revealed an average savings of $2462 for each successful version. CONCLUSION: This study identifies clinical variables associated with an increased external cephalic version success rate. If, in fact, successful external cephalic version reduces both maternal and fetal morbidity associated with cesarean delivery and, as demonstrated in this analysis, the costs associated with the delivery, then greater effort should be made to maximize the success rate of external cephalic version.

Adult↗
PubMed2003

Effect of paramedic experience on orotracheal intubation success rates.

This study's objective was to determine the effect of paramedic experience on orotracheal intubation success in prehospital adult nontraumatic cardiac arrest patients. This retrospective study analyzed all attempted intubations of prehospital adult nontraumatic cardiac arrest patients between January 1, 1997 and April 30, 1997 in an urban, all ALS service. Data were abstracted from EMS reports and intubation data forms. Variables included months of experience, number of patients in whom intubation was attempted, number of intubation attempts, success per attempt, and success per patient. Ninety-eight paramedics performed 909 intubations on 1066 cardiac arrest patients, yielding an intubation success rate of 85.3%. The median months of experience was 59.5 (Range 5-223). The median number of patients in whom intubation was attempted per paramedic was 10 (Range 1-36). The mean intubation success rate per paramedic was 80.6% (+/- 22.4, 95% CI 76.1, 85.1). There was significant correlation between total number of patients in whom intubation was attempted and intubation success rate (p <.001, R = 0.32). There was no correlation between months of experience and intubation success rate. In conclusion, the number of patients in whom intubation was attempted per paramedic was significantly correlated with the intubation success rate. Months of experience per paramedic had no significant correlation with intubation success rate.

Clinical Competence↗
PubMed1980

An analysis of learned helplessness: II. The processing of success.

Helpless children attribute their failures to lack of ability and view them as insurmountable. Mastery-oriented children, in contrast, tend to emphasize motivational factors and to view failure as surmountable. Although the performance of the two groups is usually identical during success of prior to failure, past research suggests that these groups may well differ in the degree to which they perceive that their successes are replicable and hence that their failures are avoidable. The present study was concerned with the nature of such differences. Children performed a task on which they encountered success and then failure. Half were asked a series of questions about their performance after success and half after failure. Striking differences emerged: Compared to mastery-oriented children, helpless children underestimated the number of success (and overestimated the number of failures), did not view successes as indicative of ability, and did not expect the successes to continue. subsequent failure led them to devalue ;their performance but left the mastery-oriented children undaunted. Thus, for helpless children, successes are less salient, less predictive, and less enduring--less successful.

Achievement↗
PubMedDate not supplied

Effects of electromagnetic fields on the reproductive success of American kestrels.

Reduced reproductive success of birds nesting near power lines has been documented but never directly attributed to electromagnetic fields (EMFs). Laboratory studies have identified EMF effects on embryonic development, but reproductive success of wild birds is dependent on additional factors, including fertility, egg size, hatching, and fledging success. We tested whether EMFs affect reproductive success of birds. Captive American kestrels (Falco sparverius) were bred for one season per year for 2 yr under either controlled or EMF conditions. EMF exposure was equivalent to that experienced by wild reproducing kestrels and was weakly associated with reduced egg laying in 1 yr only. In both years fertility was higher, but hatching success was lower in EMF pairs than control pairs. Fledging success was higher in EMF pairs than control pairs in 1995 only. Egg composition and embryonic development were examined in 1 yr only, but hatchlings were measured in both years. EMF eggs were larger, with more yolk, albumen, and water, but had thinner egg shells than control eggs. Late-term EMF embryos were larger and longer than control embryos, although hatchlings were similar in body mass and size. EMF exposure affected reproductive success of kestrels, increasing fertility, egg size, embryonic development, and fledging success but reducing hatching success.

Animals↗
PubMed2004

Density-dependent sexual selection in external fertilizers: variances in male and female fertilization success along the continuum from sperm limitation to sexual conflict in the sea urchin Strongylocentrotus franciscanus.

Sperm competition and female choice are fundamentally driven by gender differences in investment per offspring and are often manifested as differences in variance in reproductive success: males compete and have high variance; most females are mated and have low variance. In marine organisms that broadcast spawn, however, females may encounter either sperm limitation or sperm competition. I measured the fertilization success of male and female Strongylocentrotus franciscanus over a range of population densities using microsatellite markers. Female fertilization success first increased and then decreased with mate density, limited at low density by sperm limitation and at high density by polyspermy. Mate density affected variance in fertilization success in both males and females. In males, the variance in fertilization success increased with mate density. In females, the pattern was more complex. The variance in female success increased similarly to males with increased mate density but then decreased to low levels at intermediate densities, where almost all eggs were fertilized. As density increased further, the female variances again increased as polyspermy lowered average fertilization success. Male and female variances differed only at intermediate densities. At low densities, both sexes may be under selection to increase fertilization success; at intermediate densities, males may compete; and at high densities, both sexes may be under selection to increase success by increasing (males) or decreasing (females) likelihood of fertilization during sexual conflict. Only within a narrow range of densities do patterns of sexual selection mirror those typically noted in internally fertilizing taxa.

Animals↗
PubMed1998

Gender and physical therapy career success factors.

BACKGROUND AND PURPOSE: Gender and profession are thought to affect how career success is perceived as well as how it is achieved. This study investigated items considered important in defining career success for male and female physical therapists. The study also explored the relationship among gender, beliefs about career success, and career experiences. SUBJECTS AND METHODS: Data were obtained through an investigator-developed survey. The self-report questionnaire consisted of 78 items in 4 areas: descriptive information, items important in characterizing career success, items perceived to enhance or inhibit career success, and items assessing self-esteem. Questionnaires were mailed to a random sample of active physical therapist members of the American Physical Therapy Association (N = 5,000). The response rate was 38.1% (n = 1,906). RESULTS: Both men and women selected indicators such as practicing ethically, improving patient health, and feeling satisfied over high income or status when describing career success. All respondents agreed that clinical competency and motivation are key factors related to achieving career success. Family issues, full-time employment, and flexibility of practice conditions emerged as primary gender differences. CONCLUSION AND DISCUSSION: A unique set of indicators describe physical therapy career success. Gender differences in its description and factors that influence its achievement are related primarily to family issues. Career success for women depends to a greater degree on the ability to manage family responsibilities in conjunction with employment opportunities.

Adult↗
PubMed2004

Success rates of pediatric intubation by a non-physician-staffed critical care transport service.

OBJECTIVES: Previous researchers have found that institution of an endotracheal intubation (ETI) protocol into a large urban paramedic program resulted in low success rates and had no beneficial effects. The primary goal of the current study was to assess ETI success rates achieved by a small cadre of nonphysician critical care transport (CCT) providers. A secondary objective was to assess for association between ETI success and factors such as age group or ETI setting (eg, in-hospital, in-aircraft). DESIGN: This retrospective study analyzed transport records of consecutive pediatric patients (younger than 13 years) in whom ETI was attempted by a nurse/paramedic (RN/EMTP) CCT crew working under protocols which included neuromuscular blockade (NMB)-facilitated ETI. The CCT service performs scene and interfacility transports in helicopter, fixed-wing (airplane), and ground critical care vehicles; pediatric patients are transferred to 4 receiving tertiary care centers. Chi2 test, Fisher exact test, and logistic regression analysis (P = 0.05) examined ETI success rates and assessed for association between ETI success and various characteristics (eg, age group, ETI setting). RESULTS: The CCT crew attempted ETI in 143 patients, with success in 136 cases (95.1%). There were no unrecognized esophageal intubations. ETI success was of similar likelihood across pediatric age groups (P = 0.19) and in different ETI settings (P = 0.57). CONCLUSIONS: CCT crew airway management success was very high in all practice settings. These data support contentions that, with a high level of initial and ongoing training, nonphysician CCT crew can successfully manage pediatric airways in a variety of circumstances.

Child↗
PubMed2004

The role of male age, sperm age and mating history on fecundity and fertilization success in the hide beetle.

Models of age-related mate choice predict female preference for older males as they have proven survival ability. However, these models rarely address differences in sperm age and male mating history when evaluating the potential benefits to females from older partners. We used a novel experimental design to assess simultaneously the relative importance of these three parameters in the hide beetle, Dermestes maculatus. In a two-part experiment we first explored age-related male mating success and subsequently examined the consequences of male age, sperm age and male mating history on female fecundity and fertilization success. In a competitive mating environment, intermediate-age males gained significantly higher mating success than younger or older males. To test the consequences for females of aged-related male mating success, a second set of females were mated to males varying in age (young, intermediate-age and old), in numbers of matings and in timing of the most recent mating. We found that male age had a significant impact on female fecundity and fertilization success. Females mated to intermediate-age males laid more eggs and attained consistently higher levels of fertilization success than females with young and old mates. A male's previous mating history determined his current reproductive effort; virgin males spent longer in copula than males with prior mating opportunities. However, differences in copulation duration did not translate into increased fecundity or fertilization success. There was also little evidence to suggest that fertilization success was dependent on the age of a male's sperm. The experiment highlights the potential direct benefits accrued by females through mating with particular aged males. Such benefits are largely ignored by traditional viability models of age-related male mating success.

Age Factors↗
PubMed2004

Older adults' views of "successful aging"--how do they compare with researchers' definitions?

OBJECTIVES: To determine whether older adults have thought about aging and aging successfully and to compare their perceptions of successful aging with attributes of successful aging identified in the published literature. DESIGN: A cross-sectional, mailed survey. SETTING: King County, Washington. PARTICIPANTS: Nondemented participants from two cohorts. The first cohort, referred to as Kame, which means turtle, a symbol of longevity for Japanese, enrolled 1,985 Japanese Americans aged 65 and older and was established in 1992-94. The second cohort, Adult Changes in Thought, enrolled 2,581 white men and women aged 65 and older from a health maintenance organization and was established in 1994-96. MEASUREMENTS: Respondents were asked whether they had ever thought about aging and aging successfully and whether these thoughts had changed over the previous 20 years and about how important specific attributes, originating from the published literature, were in characterizing successful aging. RESULTS: Overall, 90% had previously thought about aging and aging successfully, and approximately 60% said their thoughts had changed over the previous 20 years. The Japanese-American group rated 13 attributes as important to successful aging; the white group rated the same 13 as important and added one additional attribute, learning new things. CONCLUSION: Older adults' definition of successful aging is multidimensional, encompassing physical, functional, psychological, and social health. In contrast, none of the published work describing attributes of successful aging includes all four dimensions. Future work would benefit from an expanded definition to adequately reflect the perceptions of older adults.

Adaptation, Psychological↗
PubMed1992

Factors predicting success in DC catheter ablation of accessory pathways.

In a series of 33 patients with accessory pathways, 26 had successful catheter ablation (fulguration [23 patients] or modification [3 patients]) of their accessory pathway conduction, and could be considered as a clinical success. One hundred thirteen single discharge or double discharge shocks were delivered, and each shock was studied to reveal which parameters were important to predict the success or failure of catheter ablation. Double discharge shocks resulted in successful accessory pathway modification or ablation twice as often as single discharge shocks (32% vs 16%). This effect was more pronounced in left lateral accessory pathways (48% vs 4%). Shocks in the electrophysiologically defined ventricular zone were more likely to be successful (33%) than shocks delivered in the atrial zone (14%), irrespective of accessory pathway location. The presence of a probable Kent potential was the parameter most strongly associated with success. The parameter most strongly associated with failure, with a 100% negative predictive value, was the absence of earliest activation recorded on the ablating catheter prior to shock delivery. An AV interval of < 60 msec significantly divided the successful from the unsuccessful shocks (P = 0.01). The VA interval during orthodromic reciprocating tachycardia or right ventricular stimulation did not allow for significant division into successful and unsuccessful attempts in this relatively short series. VA intervals, when longer, were predictive of failure but, when shorter, had low positive predictive value. Mean follow-up in 25 successful patients was 15 +/- 6 months. All patients did well in the follow-up period. Neither those patients with ablation nor modification of the accessory pathway had recurrent episodes of tachycardia or required pharmacological treatment for control of arrhythmias.

Adult↗