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  • 1
    ISSN: 1520-5827
    Quelle: ACS Legacy Archives
    Thema: Chemie und Pharmazie
    Materialart: Digitale Medien
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  • 2
    ISSN: 1540-8167
    Quelle: Blackwell Publishing Journal Backfiles 1879-2005
    Thema: Medizin
    Notizen: Defibrillation with Small Capacitance. Introduction: The size of current implantable cardioverter defibrillators (ICD) is still large in comparison to pacemakers and thus not convenient for pectoral implantation. One way to reduce ICD size is to defibrillate with smaller capacitors. A trade-off exists, however, since smaller capacitors may generate a lower maximum energy output. Methods and Results: In a prospective randomized cross-over study, the step-down defibrillation threshold (DFT) of an experimental 90-μF biphasic waveform was compared to a standard 125-μF biphasic waveform. The 90-μF capacitor delivered the same energy faster and with a higher peak voltage but provided only a maximum energy output of 20 instead of 34 J. DFTs were determined intraoperatively in 30 patients randomized to receive either an endocardial (n = 15) or an endocardial-subcutaneous array (n = 15) defibrillation lead system. Independent of the lead system used, energy requirements did not differ at DFT for the experimental and the standard waveforms (10.3 ± 4.1 and 9.5 ± 4.9 J, respectively), but peak voltages were higher for the experimental waveform than for the standard waveform (411 ± 80 and 325 ± 81 V, respectively). For the experimental waveform the DFT was 10 J or less using an endocardial lead-alone system in 10 (67%) of 15 patients and in 12 (80%) of 15 patients using an endocardial-subcutaneous array lead system. Conclusions: A shorter duration waveform delivered by smaller capacitors does not increase defibrillation energy requirements and might reduce device size. However, the smaller capacitance reduces the maximum energy output. If a 10-J safety margin between DFT and maximum energy output of the ICD is required, only a subgroup of patients will benefit from 90-μF ICDs with DFTs feasible using current defibrillation lead systems.
    Materialart: Digitale Medien
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  • 3
    Digitale Medien
    Digitale Medien
    350 Main Street , Malden , MA 02148-5018 , USA and 9600 Garsington Road , Oxford OX4 2DQ , UK . : Blackwell Science Inc
    Pacing and clinical electrophysiology 28 (2005), S. 0 
    ISSN: 1540-8159
    Quelle: Blackwell Publishing Journal Backfiles 1879-2005
    Thema: Medizin
    Notizen: This is a report on a patient with an implanted cardioverter defibrillator (ICD) who intentionally underwent magnetic resonance imaging (MRI) of a malignant brain tumor. To avoid inadequate detection of ventricular tachycardia (VT) or ventricular fibrillation (VF), the ICD was inactivated by programming the VT-detection and VT/VF-therapy status off. The patient came through the protocol safely and without any difficulty or discomfort. There was no arrhythmic event. MRI affected neither programmed data nor the function of the ICD system.
    Materialart: Digitale Medien
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  • 4
    Digitale Medien
    Digitale Medien
    350 Main Street , Malden , MA 02148-5018 , USA and 9600 Garsington Road , Oxford OX4 2DQ , UK . : Blackwell Science Inc
    Pacing and clinical electrophysiology 28 (2005), S. 0 
    ISSN: 1540-8159
    Quelle: Blackwell Publishing Journal Backfiles 1879-2005
    Thema: Medizin
    Notizen: Background: Implantation of an additional pace/sense (P/S) lead is commonly used in patients with implantable cardioverter/defibrillators (ICDs) to overcome P/S defects of integrated defibrillation leads (HV-P/S leads). No information is available about the clinical outcome and the incidence of complications in these patients. Methods: Retrospective analysis was performed in 151 patients (125 male, age 54.9 ± 13.6 years, LVEF 48.1 ± 17.8%, CAD in 86 [57%], DCM in 24 [16%], ARVCM in 11 [7%]) who received an additional P/S lead between 1990 and 2002 (54 patients with abdominal and 97 patients with pectoral ICD system). Statistical analysis was done using Kaplan-Meier survival curves. Results: The average follow-up (FU) after implantation of the additional P/S lead was 43 ± 27 months. In total 117 patients [77.5%] remain implanted; 22 patients died due to cardiac-related reasons. After a FU of 23 ± 23 months, 43 patients [28.5%] experienced lead-related problems after implantation of the additional P/S lead: oversensing in 23 [53.5%], insulation defect in 3 [7.0%], fracture in 1 [2.3%], system infection in 4 [9.3%], and defect of the HV-P/S lead in 6 [14.0%] patients. The event-free cumulative survival of the additional P/S lead after 1, 2, and 5 years was 87.0%, 79.8%, and 59.4%, respectively (for pectoral leads: 89.6%, 82.0%, and 60.0%, respectively). Conclusions: Implantation of an additional P/S lead in case of failure of an HV-P/S lead is safe. However, it is associated with a substantial rate of complications during FU. Therefore, extraction of damaged defibrillation leads instead of implantation of P/S leads should be favored.
    Materialart: Digitale Medien
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  • 5
    ISSN: 1540-8159
    Quelle: Blackwell Publishing Journal Backfiles 1879-2005
    Thema: Medizin
    Notizen: GRADAUS, R., et al.: Implantation of a Dual Chamber Pacing and Sensing Single Pass Defibrillation Lead. Dual-chamber ICDs are increasingly used to avoid inappropriate shocks due to supraventricular tachycardias. Additionally, many ICD patients will probably benefit from dual chamber pacing. The purpose of this pilot study was to evaluate the intraoperative performance and short-term follow-up of an innovative single pass right ventricular defibrillation lead capable of bipolar sensing and pacing in the right atrium and ventricle. Implantation of this single pass right ventricular defibrillation lead was successful in all 13 patients (age 63 ± 8 years; LVEF 0.44 ± 0.16; New York Heart Association [NYHA] 2.4 ± 0.4, previous open heart surgery in all patients). The operation time was 79 ± 29 minutes, the fluoroscopy time 4.7 ± 3.1 minutes. No perioperative complications occurred. The intraoperative atrial sensing was 1.7 ± 0.5 mV, the atrial pacing threshold product was 0.20 ± 0.14 V/ms (range 0.03–0.50 V/ms). The defibrillation threshold was 8.8 ± 2.7 J. At prehospital discharge and at 1-month and 3-month follow-up, atrial sensing was 1.9 ± 0.9, 2.1 ± 0.5, and 2.7 ± 0.6 mV, respectively, (P = NS, P 〈 0.05, P 〈 0.05 to implant, respectively), the mean atrial threshold product 0.79, 1.65, and 1.29 V/ms, respectively. In two patients, an intermittent exit block occurred in different body postures. All spontaneous and induced ventricular arrhythmias were detected and terminated appropriately. Thus, in a highly selected patient group, atrial and ventricular sensing and pacing with a single lead is possible under consideration of an atrial pacing dysfunction in 17% of patients.
    Materialart: Digitale Medien
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  • 6
    ISSN: 1540-8159
    Quelle: Blackwell Publishing Journal Backfiles 1879-2005
    Thema: Medizin
    Notizen: New developments in dual chamber implantable cardioverter defibrillators (ICD) have increased the specificity of therapy delivery. This study was performed to examine the performance of an algorithm, focusing on its ability to distinguish slow ventricular tachycardia (VT) from sinus rhythm or supraventricular tachyarrhythmias. The patient population included 77 men and 13 women, 63 ± 11 years old, treated with ICDs after episodes of spontaneous or inducible ventricular tachyarrhythmias. They were randomized to programming of the ICD to a lower limit of VT detection at 128 beats/min (group I, n = 44), versus 153 beats/min II (group II, n = 46). The primary endpoint of the study consisted of comparing the specificity and sensitivity of the algorithm between the two groups of patients. Over a 10.1 ± 3.5 months follow-up, 325 episodes were detected in the Tachy zone in group I, versus 106 in group II. The sensitivity and specificity of the algorithm in group I were 98.8% and 94.4%, respectively, versus 100% and 89% in group II (NS). A single episode of VT at a rate of 132 beats/min was diagnosed as SVT in group I. The sensitivity and specificity of the algorithm for tachycardias 〈153 beats/min were 97.4% and 94.5%, respectively. Overall VT therapy efficacy was 100% in both groups. The performance of this algorithm in the slow VT zone supports the programming of a long Tachy detection interval to document slow events, and allows to treat slow VT, if necessary, without significant risk of inappropriate interventions for sinus tachycardia. (PACE 2003; 26:2275–2282)
    Materialart: Digitale Medien
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  • 7
    Digitale Medien
    Digitale Medien
    350 Main Street , Malden , MA 02148-5018 , USA . : Blackwell Futura Publishing, Inc.
    Pacing and clinical electrophysiology 26 (2003), S. 0 
    ISSN: 1540-8159
    Quelle: Blackwell Publishing Journal Backfiles 1879-2005
    Thema: Medizin
    Notizen: GRADAUS, R., et al.: ICD Leads: Design and Chronic Dysfunctions. The treatment of ventricular tachyarrhythmias has changed over the last 10 years. Implantable cardioverter defibrillators (ICDs), once used only as a last resort therapy, have now become the treatment of choice. This change occurred before the first results of randomized studies on ICD therapy in patients with life-threatening ventricular tachyarrhythmias were published by the end of 1997. Technological advances of ICD therapy, in particular the development of transvenous leads, were to a large extent responsible for this change. Modern leads are characterized by their multilumen design that incorporates straight wires and coiled conductors into a single electrode body. Conductors and insulation are sheathed with additional insulation layers. The most frequently used insulating materials are silicone, polyurethane, and fluoropolymers. Lead failures are an important complication of ICD therapy. Fractured conductors, compression, creeping, or insulation defects from abrasion can cause such lead dysfunctions. Chronically implanted leads will inevitably have an increased risk of failure due to defects despite all technological advances. In the light of improving survival figures in patients with ventricular tachyarrhythmias and increasing numbers of ICD implantations, lead failures are becoming a clinical problem of ever increasing importance. Therefore, the question of which lead types necessitate extraction when a certain failure occurs and which leads can be left in place. Despite continuous improvements in lead extraction systems and growing experience in their use, the extraction of any pacemaker or ICD lead is associated with some risk of complications. (PACE 2003; 26[Pt. I]:649–657)
    Materialart: Digitale Medien
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  • 8
    Digitale Medien
    Digitale Medien
    Oxford, UK : Blackwell Futura Publishing, Inc.
    Pacing and clinical electrophysiology 25 (2002), S. 0 
    ISSN: 1540-8159
    Quelle: Blackwell Publishing Journal Backfiles 1879-2005
    Thema: Medizin
    Notizen: GRADAUS, R., et al.: Effect of Ventricular Fibrillation Duration on the Defibrillation Threshold in Humans. Early during ventricular fibrillation, the defibrillation threshold may be low, as ventricular fibrillation most probably arises from a localized area with only a few wavefronts and the effects of global ischemia, ventricular dilatation, and sympathetic discharge have not yet fully developed. The purpose of this study was to explore the effect of the timing of shock delivery in humans. During implantation of an ICD in 26 patients (24 men, 60 ± 11 years, 19 coronary artery disease, NYHA 2.2 ± 0.4, left ventricular ejection fraction 0.42 ± 0.16), the defibrillation threshold was determined after approximately 10 and 2 seconds of ventricular fibrillation. Ventricular fibrillation was induced by T wave shocks. Mean defibrillation threshold was 9.9 ± 3.6 J after 10.3 ± 1.0 seconds. Within 2 seconds, 20 of 26 patients could be successfully defibrillated with ≤ 8 J. In these patients, the mean defibrillation threshold was 4.0 ± 2.1 J after 1.4 ± 0.3 seconds compared to 9.5 ± 3.1 J after 10.2 ± 1.1 seconds (P 〈 0.001). There were no clinical differences between patients who could be successfully defibrillated within 2 seconds and those patients without successful defibrillation within 2 seconds. In the majority of patients, the defibrillation threshold was significantly lower within the first few cycles of ventricular fibrillation than after 10 seconds of ventricular fibrillation. These results should lead to exploration of earlier shock delivery in implantable devices. This could possibly reduce the incidence of syncope in patients with rapid ventricular tachyarrhythmias and ICDs.
    Materialart: Digitale Medien
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  • 9
    Digitale Medien
    Digitale Medien
    350 Main Street , Malden , MA 02148-5018 , USA . : Blackwell Futura Publishing, Inc.
    Pacing and clinical electrophysiology 26 (2003), S. 0 
    ISSN: 1540-8159
    Quelle: Blackwell Publishing Journal Backfiles 1879-2005
    Thema: Medizin
    Notizen: BORIANI, G., et al.: Evaluation of a Dual Chamber Implantable Cardioverter Defibrillator for the Treatment of Atrial and Ventricular Arrhythmias. Eighty-nine patients with a documented history of atrial tachyarrhythmias or fibrillation (AF) received a cardioverter defibrillator designed to selectively differentiate and treat atrial and ventricular arrhythmias. Twenty-two patients received a coronary sinus lead and, therefore, could use a separate shock vector for selective treatment of atrial tachyarrhythmias/AF. The device is designed to treat tachyarrhythmias with antitachycardia pacing (ATP) and/or shock therapy using an atrial and/or a ventricular shock vector. Patients underwent induction and shock termination of atrial or dual tachyarrhythmias (AF/VF) to verify proper device function and to measure the arrhythmia detection time with enhancements and preventive algorithms programmed On and Off, respectively. Detection time for 329 VF inductions was 2.41 ± 0.64  seconds with enhancements On and 2.29 ± 0.47 with enhancements Off (NS). At implant or predischarge, 283 AF and/or AF/VF (121 atrial and 162 atrial/ventricular fibrillation) were induced. Shock conversion efficacy was 89.8% with AF conversion energies ranging from 0.9 to 27 J. Thirteen of the 23 patients had atrial shock conversions using the separate shock vector with an average conversion energy of 1.9 ± 1.4  J . (range 0.5–5 J). During follow-up the efficacy of ATP on atrial tachyarrhythmias was 59% and the efficacy of delivered shocks on AF was 85%. This new dual chamber cardioverter defibrillator appropriately detected and classified atrial arrhythmias, and shock therapy for AF was highly effective. The detection algorithm differentiated atrial tachyarrhythmia/AF and did not delay VF detection. The separate shock vector converted induced AF with energies ranging from 0.6 to 5 J. (PACE 2003; 26[Pt. II]:461–465)
    Materialart: Digitale Medien
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  • 10
    ISSN: 1540-8159
    Quelle: Blackwell Publishing Journal Backfiles 1879-2005
    Thema: Medizin
    Notizen: GRÖNEFELD, G.C., et al.: Morphology Discrimination: A Beat-to-Beat Algorithm for the Discrimination of Ventricular From Supraventricular Tachycardia by Implantable Cardioverter Defibrillators. Inappropriate therapy of SVTs by ICDs remains a major clinical problem despite enhanced detection criteria like “sudden onset” and “rate stability” in third-generation devices. Electrogram morphology discrimination offers an additional approach to improve discrimination of supraventricular tachycardia (SVT) from ventricular tachycardia (VT). In a prospective, multicenter study, patients received an ICD with a beat-to-beat algorithm for morphological analysis of the intracardiac electrogram (Morphology Discrimination, MD). A nominal programming for standard enhancement criteria and morphology discrimination was required at implant. Electrogram storage of tachycardia episodes irrespective of delivery of therapy was used to assess sensitivity and specificity of the morphology algorithm alone and in combination with established detection criteria. During a 12 6 6-month follow-up, 886 episodes of device stored electrograms from 82 of 256 patients were evaluated. At nominal settings, the MD algorithm correctly identified 423 of 551 episodes as VT resulting in sensitivity of 77%. The classification of SVT was met in 239 of 335 episodes resulting in specificity of 71%. In combination with sudden onset, sensitivity increased to 99.5% at the expense of specificity (48%). In conclusion, SVT-VT discrimination based on morphological analysis alone results in limited sensitivity and specificity. Programming the monitor mode allows individual assessment of the performance of this detection enhancement feature during clinical followup without compromising device safety. Only in patients with documented efficacy of morphology discrimination should this feature be subsequently activated.
    Materialart: Digitale Medien
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