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  • 1
    Electronic Resource
    Electronic Resource
    Sick sinus syndrome and diffuse impairment of the conduction system in a child: Successful pacing with a steroid eluting endocardial pacing lead (1992)
    Springer
    Pediatric cardiology 13 (1992), S. 44-47 
    Details
    ISSN: 1432-1971
    Keywords: Atrial flutter ; Atrioventricular block ; Pacemaker ; Sick sinus syndrome
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary A 9-year-old patient who had had a syncope was found to have atrial flutter in a resting electrocardiogram (ECG). Brief phases of sinus arrest had previously occurred after drug conversion to sinus rhythm. Structural heart disease was excluded by cardiac catheterization and angiography. Electrophysiologic study revealed a sick sinus syndrome, associated with diffuse impairment of the conduction system (supra-, infra-, and intrahisian block). Epimyocardial and an endocardial pacemaker implantation failed because of high stimulation threshold, after 3 years and 2 weeks, respectively. At the third implantation a steroid-eluting endocardial pacing lead was used and satisfactory pacing was still present 2 years later.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00788230
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    Paper (German National Licenses)
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  • 2
    Electronic Resource
    Electronic Resource
    Minimal effective concentration values of propafenone and 5-hydroxy-propafenone in acute and chronic therapy (1990)
    Springer
    Cardiovascular drugs and therapy 4 (1990), S. 281-287 
    Details
    ISSN: 1573-7241
    Keywords: antiarrhythmic therapy ; pharmacokinetics ; propafenone ; ventricular premature beats
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary We evaluated the antiarrhythmic efficacy and the minimal effective concentrations of propafenone and its metabolite 5-hydroxy-propafenone during a) acute intravenous infusion (1.5 mg/kg in bolus followed by 45 minutes infusion), b) an acute oral single-dose test (450 mg), and c) 14-day chronic therapy (300 mg tid) followed by a washout. Oxidative metabolism was assessed by a debrisoquine oral test in every patient. Eleven patients with stable ventricular premature beats (VPBs)≥300/hr and Lown class ≥ 3 completed the study. The main results emphasized a certain discrepancy between the clinical effect of the acute intravenous infusion (efficacy in 5 out of 11 patients) and of the acute oral test and chronic therapy (efficacy in 11/11), with a time lag of the ECG changes during the acute intravenous infusion. The minimal effective concentrations were lower after acute oral administration compared with chronic treatment both for propafenone (200±189 ng/ml vs. 492±530 ng/ml; p〈0.05) and for 5-hydroxy-propafenone (82±40 ng/ml vs. 149±80 ng/ml; p〈0.02). A linear correlation was demonstrated between drug/metabolite ratios of propafenone and debrisoquine, either after acute oral (r=0.91) or after chronic administration (r=0.84). The pharmacokinetics of propafenone was nonlinear and showed wide interindividual variations. In conclusion, a) the lower efficacy and delayed electrophysiologic effects of propafenone after intravenous administration suggest that longer infusion times are necessary for complete antiarrhythmic efficacy; b) the differences observed in the minimal effective concentrations of acute versus chronic oral therapy suggest the development of partial tolerance to propafenone during chronic treatment.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01857646
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    Paper (German National Licenses)
    Fulltext
  • 3
    Electronic Resource
    Electronic Resource
    Effect of enoximone alone and in combination with metoprolol on myocardial function and energetics in severe congestive heart failure: Improvement in hemodynamic and metabolic profile (1993)
    Springer
    Cardiovascular drugs and therapy 7 (1993), S. 337-347 
    Details
    ISSN: 1573-7241
    Keywords: myocardial energetics ; congestive heart failure ; enoximone ; beta-adrenergic blockade ; metoprolol
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary The hemodynamic and myocardial metabolic effects of enoximone (phosphodiesterase III inhibitor), alone or in combination with metoprolol (beta-adrenergic blocker), were studied in patients with congestive heart failure. Ten patients (New York Heart Association Class III–IV) underwent right heart and coronary sinus catheterization, and parameters were assessed at basal condition, at peak enoximone response (mean intravenous loading dose=2.2 mg/kg), and after the combination with metoprolol (mean intravenous dose=8.5 mg). Heart rate tended to increase during enoximone administration (from 102±16 to 107±16 min−1, ns) and was reduced during enoximone plus metoprolol (to 88±15 min−1, p〈0.05 vs. basal). Cardiac index was increased during enoximone (from 2.2±0.2 to 3.8±0.5 1/min/m2, p〈0.05) and decreased during enoximone plus metoprolol (to 2.8±0.5 1/min/m2, p〈0.05 vs. enoximone). Mean pulmonary wedge pressure fell during enoximone and remained reduced during enoximone plus metoprolol (from 27±9 to 9±3 and to 13±4 mmHg, respectively, both p〈0.05). Myocardial oxygen consumption did not change during enoximone (from 27±8 to 25±13 ml/min, ns) and was reduced during enoximone plus metoprolol (to 19±8 ml/min, p〈0.05 vs. basal). Myocardial lactate extraction tended to be lower during enoximone and during enoximone plus metoprolol conditions (from 38±17% to 26±20% and to 29±24%, respectively), but no statistical significance was found. Myocardial efficiency was increased during enoximone and during enoximone plus metoprolol (from 9±3% to 15±6% and to 14±6%, respectively, both p〈0.05). Thus in patients with congestive heart failure enoximone improves hemodynamics and, in most cases, it does not influence energetics. The addition of metoprolol to enoximone reduces heart rate, cardiac index, and myocardial oxygen consumption without any other major changes, producing a more physiologic hemodynamic and metabolic profile.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00880157
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    Paper (German National Licenses)
    Fulltext
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