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  • 1
    Electronic Resource
    Electronic Resource
    Safety and Efficacy of Angiographic Guided Elective Palmaz-Schatz Stent Implantation Without Coumadin: Comparison of Stent Implantation and Angioplasty (1997)
    Oxford, UK : Blackwell Publishing Ltd
    Journal of interventional cardiology 10 (1997), S. 0 
    Details
    ISSN: 1540-8183
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: This study was designed to evaluate the safety and efficacy of routine high-pressure Palmaz-Schatz coronary stenting in patients with symptomatic coronary heart disease with only angiographic guidance without coumadin for poststenting treatment. Intracoronary stenting reduces restenosis rate after coronary angioplasty. High pressure stent deployment with intravascular ultrasound guidance reduces the incidence of stent thrombosis, despite reduction of anticoagulation. However, the feasibility of routine stent implantation with only angiographic guidance and without coumadin for poststenting treatment has not yet been determined. Patients undergoing coronary angioplasty for symptomatic coronary heart disease received stent implantation for abrupt or threatening vessel occlusion, vessel dissection without compromised antegrade blood flow (but at high risk for subacute occlusion and early restenosis), unsatisfactory angioplasty result with 〉 30% residual stenosis, and elective stent implantation in de novo lesions, restenotic lesions, and lesions in bypass grafts. Quantitative coronary analysis was performed before the procedure, immediately after, and at follow-up 6 ± 1 (SD) months later. This patient group was matched for clinical and angiographic characteristics with those patients who underwent balloon angioplasty during the same period. Patients who underwent coronary stenting had larger net gain (1.95 ± 1.0 vs 1.42 ± 0.9; P 〈 0.001) resulting in a larger minimal luminal diameter (2.48 ± 1.19 vs 1.78 ± 1.01; P 〈 0.001) at follow-up as compared with balloon angioplasty. Restenosis, defined as 〉 50% diameter stenosis at follow-up, occurred in 35.0% in the PTCA group and in 16.1% in the stent group (P 〈 0.001). Subacute stent thrombosis occured in one patient (0.8%) due to angiographically evident suboptimal stent expansion. Routine coronary high pressure Palmaz-Schatz stenting with angiographie guidance without coumadin for poststenting treatment represents a safe and effective option in patients with symptomatic coronary heart disease without increasing the incidence of (sub)acute stent thrombosis.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1540-8183.1997.tb00040.x
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  • 2
    Electronic Resource
    Electronic Resource
    Maintenance of Sinus Rhythm after Cardioversion of Atrial Fibrillation in Patients with Lone Atrial Fibrillation and Patients with Hypertension (1998)
    Oxford, UK : Blackwell Publishing Ltd
    Annals of noninvasive electrocardiology 3 (1998), S. 0 
    Details
    ISSN: 1542-474X
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Background: The success rate and prognosis of cardioversion of atrial fibrillation (AF) in patients with organic heart disease is well known. In contrast, little data exist about cardioversion success and maintenance of sinus rhythm (SR) in patients with lone AF and in patients with hypertension as the only underlying cardiovascular disease.Methods: In a prospective cardioversion registry 148 of 181 patients (81.8%) with lone AF (age 58 ± 13 years, duration of AF 7.6 ± 19 weeks) and 120 of 148 patients (81.1%) with hypertension (age 62 ± 10 years, duration of AF 6.6 ± 21 weeks) had successful cardioversion and were followed for 7.7 ± 1.9 months.Results: At follow-up, 120 patients (81.1%) with lone AF were in SR, and 18 of these patients had had repeated cardioversion during follow-up (AF total recurrence rate 31.1%). In stepwise regression analysis, the number of previous cardioversions was predictive of rhythm at follow-up (P = 0.0453). Rhythm at follow-up did not differ between patients who were or were not on antiarrhythmic drugs. At follow-up 96 patients (80%) with hypertension were in SR, and 9 of these had had repeated cardioversion during follow-up (AF total recurrence rate 27.5%). As in lone AF, the recurrence rate of AF did not differ between patients with or without antiarrhythmic drug treatment, and in multivariate regression analysis, the number of previous cardioversions was the only clinical predictor of rhythm at follow-up (P = 0.0284).Conclusions: Even in patients with such benign conditions as lone AF or hypertension as the only underlying disease, the prognosis of cardioversion in terms of maintenance of SR is poor. Future studies of rhythm control versus rate control need to include not only patients with organic heart disease but also patients with lone AF and patients with hypertension, since the long-term benefits of these two strategies remain unclear even in these subsets of patients.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1542-474X.1998.tb00405.x
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  • 3
    Electronic Resource
    Electronic Resource
    Prospective Randomized Comparison of Two Defibrillation Safety Margins in Unipolar, Active Pectoral Defibrillator Therapy (2003)
    350 Main Street , Malden , MA 02148-5018 , USA . : Blackwell Futura Publishing, Inc.
    Pacing and clinical electrophysiology 26 (2003), S. 0 
    Details
    ISSN: 1540-8159
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: CARLSSON, J., et al.: Prospective Randomized Comparison of Two Defibrillation Safety Margins in Unipolar, Active Pectoral Defibrillator Therapy. Various techniques are used to establish defibrillation efficacy and to evaluate defibrillation safety margins in patients with an ICD. In daily practice a safety margin of 10 J is generally accepted. However, this is based on old clinical data and there are no data on safety margins using current ICD technology with unipolar, active pectoral defibrillators. Therefore, a randomized study was performed to test if the likelihood of successful defibrillation at defibrillation energy requirement (DER) +5 J and +10 J is equivalent. Ninety-six patients (86 men; age 61.0 ± 10.3 years; ejection fraction 0.341 ± 0.132 ; coronary artery disease [n = 65],dilated cardiomyopathy [n = 18], other [n = 13]) underwent implantation of an active pectoral ICD system with unidirectional current pathway and a truncated, fixed tilt biphasic shock waveform. The defibrillation energy requirement (DER) was determined with the use of a step-down protocol (delivered energy 15, 10, 8, 6, 4, 3, 2 J). The patients were then randomized to three inductions of ventricular fibrillation at implantation and three at predischarge testing with shock strengths programmed to DER + 5 J at implantation and + 10 J at predischarge testing or vice versa. The mean DER in the total study population was7.88 ± 2.96 J. The number of defibrillation attempts was 288 for +5 J and 288 for +10 J. The rate of successful defibrillation was 94.1% (DER + 5 J) and 98.9% (DER + 10 J;P 〈 0.01for equivalence). Charge times for DER + 5 J were significantly shorter than for DER + 10 J (3.65 ± 1.14vs5.45 ± 1.47 s; P 〈 0.001). A defibrillation safety margin of DER + 5 J is associated with a defibrillation probability equal to the standard DER + 10 J. In patients in whom short charge times are critical for avoidance of syncope, a safety margin of DER + 5 J seems clinically safe for programming of the first shock energy. (PACE 2003; 26[Pt. I]:613–618)
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1046/j.1460-9592.2003.00102.x
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  • 4
    Electronic Resource
    Electronic Resource
    Shock Coordinated with High Power of Morphology Electrogram Improves Defibrillation Success in Patients with Implantable Cardioverter Defibrillators (2002)
    Oxford, UK : Blackwell Futura Publishing, Inc.
    Pacing and clinical electrophysiology 25 (2002), S. 0 
    Details
    ISSN: 1540-8159
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: BERKOWITSCH, A., et al.: Shock Coordinated with High Power of Morphology Electrogram Improves Defibrillation Success in Patients with Implantable Cardioverter Defibrillators. Animal studies have suggested that the success of defibrillation may depend on the properties of VF waveform obtained from the morphology electrogram (ME) at the time of the shock. The reliable identification of depolarization events in the fibrillatory signal can be achieved using adaptive estimation of the instantaneous signal power (P). The aim of this study was to investigate if a high P of the ME (PME) was related to ventricular DFT and if the upslope in ME can be associated with the depolarization event. A total of 575 VF (mean duration 10 s) episodes recorded and stored during ICD implantation in 77 patients with ventricular arrhythmias were used for analysis. The DFT was defined using a double step-down test. The values of PME immediately before pulse delivery (Pshock) and shock outcomes were registered. The differences between Pshock of successful and failed defibrillation were tested with the Mann-Whitney U test. The relationship between individual medians of Pshock (Pmed) and DFT was analyzed using the Kruskall-Wallis H-test. The coincidence between identified depolarization and upslope in ME was tested using the chi-square test. A P value of 0.05 was set for an error probability. The Pshock in case of failed defibrillation was significantly lower than Pshock in successful cases by the pulses of any strength (P 〈 0.001). The test revealed a significant inverse correlation between Pmed and DFT with P 〈 0.001. The depolarization corresponded to the upslope of ME in 85% of cases. This study demonstrated that a high value of instantaneous power of ME indicates the optimal time for shock delivery. The implementation of this algorithm in ICDs may improve the defibrillation efficacy.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1046/j.1460-9592.2002.01293.x
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  • 5
    Electronic Resource
    Electronic Resource
    Quality-of-Life in Patients with Paroxysmal Atrial Fibrillation After Catheter Ablation: (2003)
    350 Main Street , Malden , MA 02148-5018 , U.S.A . : Blackwell Publishing Inc
    Pacing and clinical electrophysiology 26 (2003), S. 0 
    Details
    ISSN: 1540-8159
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: ERDOGAN, A., et al.: Quality-of-Life in Patients with Paroxysmal Atrial Fibrillation After Catheter Ablation: Results of Long-Term Follow-Up. Paroxysmal atrial fibrillation (PAF) significantly impairs patients' quality-of-life (QOL). The effect on QOL of recently developed ablation techniques with curative intention has not been studied. Thirty patients (21 men, age 54.1 ± 9.5 years) with PAF (duration 5.6 ± 5.2 years) who failed antiarrhythmic (3.8 ± 1.2 trials) drug therapy underwent catheter ablation. The follow-up time was 33.9 ± 11 months. QOL was assessed preablation, 3, 6, 9, 12, 24, and 36 months after catheter ablation. The Medical Outcomes Survey Short-Form (SF-36), scored on a 0–100 scale for each of eight domains: bodily pain, general health, mental health, physical functioning, role-emotional, role-physical, social functioning, and vitality, was used. Simultaneously, patients filled out a symptom-specific checklist (SSC) with seven clinical items scored 1–4 (1 best): dyspnea, nausea, palpitations, anxiety, syncope, presyncope, and NYHA classification. Patients with successful catheter ablation had a significant benefit in seven of eight subscales while patients with recurrence had an impact on QOL in two of eight subscales. Using SSC, a successful ablation influenced scores in all seven items while patients with recurrence had a significant change of clinical symptoms in only one item, anxiety. The subscales of the study group compared to a healthy population show higher scores after 24 months of follow-up. Patients with PAF experience a significant improvement in QOL after a successful catheter ablation. In contrast, in patients with recurrence of PAF the QOL showed improvement to a lesser extent and patients experienced ongoing symptoms. (PACE 2003; 26:678–684)
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1046/j.1460-9592.2003.00117.x
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  • 6
    Electronic Resource
    Electronic Resource
    Myocardial Injury During Radiofrequency Catheter Ablation: Comparison of Focal and Linear Lesions (2001)
    Oxford, UK : Blackwell Futura Publishing, Inc.
    Pacing and clinical electrophysiology 24 (2001), S. 0 
    Details
    ISSN: 1540-8159
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: CARLSSON, J., et al.: Myocardial Injury During Radiofrequency Catheter Ablation: Comparison of Focal and Linear Lesions. The aim of study was to investigate the extent of myocardial injury incurred by creation of continuous RF current induced linear ablation lesions (LL; ablation of atrial fibrillation, right atrial procedure) in comparison to focal RF lesions (FL; AV node reentry tachycardia, WPW tachycardia). In 23 patients with LL (age 51.3 ± 11.2 years, 18 men, 5 women) and in 16 patients with FL (age 53.9 ± 5.1 years, 8 men and 8 women), levels of creatine kinase (CK), myoglobin (MG), CKMB mass (CKMB M), CKMB activity (CKMB A), and cardiac troponin T (cTnT) were determined before and 2, 4, 8, 24, and 48 hours after ablation. CKMB A was normal in 87% in LL and 100% in FL (〈 6% of CK) with median maximum CK values of 214 (45–1583) U/L in LL and 36 (29–212) U/L in FL. Peak values of all parameters were significantly higher in LL than in FL. The sensitivity of cTnT was 50% in FL and 100% in LL. In FL MG, total CK, and CKMB M were abnormal in only 12.5% of cases while in LL MG and CKMB M were pathological in 100% and total CK was abnormal in 91.3% of patients. The amount of energy and number of RF applications correlated with cTnT, MG, and CKMB M (P = 0.01). In conclusion, (1) long linear RF current lesions for ablation of atrial fibrillation are associated with significantly greater myocardial injury than focal ablations. (2) In focal lesions only cTnT provided a sensitivity of 50% in the detection of myocardial injury while in linear lesions cTnT, CKMBM, and CKMB M seemed suitable for detection of RF current induced myocardial damage with 100% sensitivity. All biochemical parameters do not differentiate patients with coronary ischemia up to 48 hours after an ablation. (3) Further investigations are necessary to determine if RF current linear lesions lead to impaired atrial contractility in cases of extensive tissue damage.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1046/j.1460-9592.2001.00962.x
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  • 7
    Electronic Resource
    Electronic Resource
    Therapy of Atrial Fibrillation: Rhythm Control Versus Rate Control (2000)
    Oxford, UK : Blackwell Publishing Ltd
    Pacing and clinical electrophysiology 23 (2000), S. 0 
    Details
    ISSN: 1540-8159
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1540-8159.2000.tb00861.x
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  • 8
    Electronic Resource
    Electronic Resource
    Possible Role of Epicardial Left Ventricular Programmed Stimulation in Brugada Syndrome (2001)
    Oxford, UK : Blackwell Futura Publishing, Inc.
    Pacing and clinical electrophysiology 24 (2001), S. 0 
    Details
    ISSN: 1540-8159
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: CARLSSON, J., et al.: Possible Role of Epicardial Left Ventricular Programmed Stimulation in Brugada Syndrome. A patient with recurrent syncope due to polymorphic ventricular tachcardia was diagnosed with Brugada syndrome. Programmed right ventricular stimulation could not induce arrhythmia. Epicardial stimulation from a left ventricular site through the coronary sinus led to polymorhic VT. The stimulation protocol for risk stratification in Brugada syndrome is discussed.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1046/j.1460-9592.2001.00247.x
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  • 9
    Electronic Resource
    Electronic Resource
    Electrophysiological Heterogeneity of Atrial Fibrillation and Local Effect of Propafenone in the Human Right Atrium: Analysis Based on Symbolic Dynamics (2000)
    Springer
    Journal of interventional cardiac electrophysiology 4 (2000), S. 383-394 
    Details
    ISSN: 1572-8595
    Keywords: atrial fibrillation ; mapping ; basket catheter ; symbolic dynamics ; algorithmic complexity
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract A recently developed algorithm that is based on symbolic dynamics and computation of the normalized algorithmic complexity (Cα) was applied to basket-catheter mapping of the atrial fibrillation (AF). The aim of our study was to analyze the spatial distribution of the Cα during AF and effects of propafenone on this distribution. During right atrial mapping in 25 patients with AF 31 intra-atrial and 1 surface bipolar channels were acquired. The anatomical location of the intra-atrial electrodes was defined fluoroscopically. Cα was calculated for a moving window (size: 2000 points; step 500 points). Generated Cα was analyzed within 10 minutes before and after administration of propafenone. The inter-regional Cα distribution was analyzed using the Friedman-test (intra-individually) and Kruskall-Wallis-H-test (inter- individually). A value of p=0.05 was set for an error probability. Inter-regional Cα differences were found in all patients (p〈0.001). The right atrium could be divided in high- and low complexity areas according to individual patterns. A significant Cα increase in cranio-caudal direction (with the exception of septum) was confirmed inter-individually (p〈0.01). The administration of propafenone enlarged the areas of low complexity. Conclusions: This new method utilizing the combination of symbolic dynamics and adaptive power estimation can provide complex evaluation of the dynamics of AF in man. High-density mapping will be required for further evaluation of results.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1023/A:1009846232715
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  • 10
    Electronic Resource
    Electronic Resource
    Homogeneity and Diameter of Linear Lesions Induced With Multipolar Ablation Catheters: In Vitro and In Vivo Comparison of Pulsed Versus Continuous Radiofrequency Energy Delivery (2000)
    Springer
    Journal of interventional cardiac electrophysiology 4 (2000), S. 655-661 
    Details
    ISSN: 1572-8595
    Keywords: linear lesions ; catheter ablation ; pulsed energy delivery
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Background: For invasive treatment of atrial fibrillation, linear lesions induced with multipolar ablation catheters (MAC) are needed to prevent recurrence. The aim of the study was to compare the efficacy of pulsed versus continuous radiofrequency (RF)-energy delivery using MAC. Methods: In vitro tests were performed using endomyocardial preparations of fresh pig hearts in a 10-liter-bath of physiologic saline solution (37°C) at constant flow conditions (1.5[emsp4 ]l/min). The MAC were placed with a constant pressure of 20 ponds onto the endocardium. The energy (generator: Osypka HAT 200 S) was delivered either pulsed (4 electrodes simultaneously, 5[emsp4 ]ms duty-cycle) or continuously (each electrode separately). In vivo experiments were performed in 6 anesthetized pigs using fluoroscopic positioning of MAC at 40 different intracardial positions and with similar conditions as in vitro experiments. Lesion volume (LV) was calculated after measuring lesion diameter with a microcaliper. The homogeneity of the lesions (LH) was classified from 1–4; with 1 as highest homogeneity. Results: Pulsed energy delivery produced more homogeneous linear lesions in significantly less time. There was no difference in electrode temperature values (50.2±0.8 and 51.3±1.4°C) in vitro and in vivo. In the in vivo experiments, lesion depth and calculated lesion volume were less in both modes of energy delivery but pulsed energy delivery was superior regarding lesion depth and homogeneity. Conclusion: With pulsed energy delivery it is possible to create linear lesions of significantly greater homogeneity. Moreover, larger lesions are induced in less time by pulsed energy delivery in vitro and in vivo.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1023/A:1026538204579
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