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  • 1
    Electronic Resource
    Electronic Resource
    Increased Failure Rate of a Polyurethane Implantable Cardioverter Defibrillator Lead (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
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1046/j.1460-9592.2002.t01-1-00877.x
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  • 2
    Electronic Resource
    Electronic Resource
    Assessment of Radiofrequency Ablation Effect From Unipolar Pacing Threshold (2003)
    350 Main Street , Malden , MA 02148-5018 , USA , and 9600 Garsington Road , Oxford OX4 2DQ , UK . : 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: Methods for determining if an ablation lesion has been created by RF current application are limited, but needed. This study sought to determine if a change in pacing threshold at the ablation site might be used to assess creation of an ablation lesion. Peak-to-peak amplitude of the bipolar electrogram (EGM) and the unipolar pacing threshold were determined before and after creation of RF lesions using irrigated tip (63 lesions in 11 patients) or conventional ablation catheters (33 lesions in 9 patients) in infarct scars for ablation of ventricular tachycardia. The threshold was measured during continuous pacing at a cycle length of 600 ms by a decrementing output current at a pulse width of 2 ms. The unipolar pacing threshold increased by 254 ± 248% (from 5.7 ± 3.5 to 15.1 ± 6.7 mA, P 〈 0.001 ) after irrigated tip ablation and by 155 ± 144% (from 5.9 ± 3.4 to 12.3 ± 5.7 mA, P 〈 0.001 ) after conventional ablation ( P 〈 0.05 for irrigated tip vs conventional). EGM amplitude decreased by 17 ± 27% (from 0.39 ± 0.32 to 0.30 ± 0.21 mV ) after irrigated tip ablation and by 16 ± 24% (from 0.48 ± 0.27 to 0.41 ± 0.20 mV ) after conventional ablation (irrigated tip vs conventional, P = NS). There was no correlation between the change in bipolar EGM amplitude and the pacing threshold. An increase in unipolar pacing threshold is a marker of lesion creation. In regions of infarction, the relative change in threshold produced by ablation is substantially larger than the change in bipolar electrogram amplitude. The greater increase in pacing threshold after irrigated tip ablation compared to conventional ablation suggests that the magnitude of change reflects lesion size. (PACE 2003; 26:1993–1996)
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1046/j.1460-9592.2003.00307.x
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  • 3
    Electronic Resource
    Electronic Resource
    Physician Management of Pacemaker and Implantable Cardioverter Defibrillator Advisories (2004)
    350 Main Street , Malden , MA 02148-5018 , USA and 9600 Garsington Road , Oxford OX4 2DQ , UK . : Blackwell Futura Publishing, Inc.
    Pacing and clinical electrophysiology 27 (2004), S. 0 
    Details
    ISSN: 1540-8159
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: This study was designed to determine how physicians manage pacemaker (PM) and implantable cardioverter defibrillator (ICD) recalls and safety alerts (collectively “advisories”) and to determine which factors influence physicians' clinical decisions. Although PM and ICD advisories affected over 500,000 patients in the past decade, physician clinical management of advisory devices has not been well studied. Advisories continue to occur frequently and are increasing in number and rate. Five-hundred physician members of the North American Society of Pacing and Electrophysiology (NASPE) were randomly surveyed by mail and were asked to make clinical recommendations regarding the management of various PM and ICD advisory scenarios. One hundred sixty-two physicians (32%) responded to the survey (cardiac electrophysiologist 69%, general cardiologist 22%, surgeon 6%, and other 3%). There was consensus among physicians regarding the management of some PM and ICD advisories but not others. Factors associated with a higher likelihood of physician recommendation for prophylactic advisory device replacement include: ICD implanted for secondary prevention (vs primary prevention, P 〈 0.001), pacemaker dependence (P 〈 0.001), prior appropriate ICD therapy (P 〈 0.001), higher likelihood of device malfunction (P 〈 0.001), and physician in practice 〈10 years (P = 0.02). The number of devices implanted or followed per year and physician specialty had no impact on advisory device management. Physician consensus exists regarding the management of some PM and ICD advisories and can be used to guide clinical practice. Substantial differences of opinion, however, are present regarding the management of many other advisories. Evidence based guidelines incorporating the indication for device implantation and the likelihood of device malfunction would greatly facilitate clinical management of PM and ICD advisory devices. (PACE 2004; 27:437–442)
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1540-8159.2004.00460.x
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  • 4
    Electronic Resource
    Electronic Resource
    Changing Trends in Pacemaker and Implantable Cardioverter Defibrillator Generator Advisories (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: MAISEL, W.H., et al.: Changing Trends in Pacemaker and Implantable Cardioverter Defibrillator Generator Advisories. Pacemaker and implantable cardioverter defibrillator (ICD) generator recalls and safety alerts (advisories) occur frequently, affect many patients, and are increasing in number and rate. It is unknown if advances in device technology have been accompanied by changing patterns of device advisory type. Weekly FDA Enforcement Reports from January 1991 to December 2000 were analyzed to identify all advisories involving pacemaker and ICD generators. This article represents additional analysis of previously cited advisories and does not contain additional recalls or safety alerts over those that have been previously reported. The 29 advisories (affecting 159,061 devices) from the early 1990s (1991–1995) were compared to the 23 advisories (affecting 364,084 devices) from the late 1990s (1996–2000). While the annual number of device advisories did not change significantly, ICD advisories became more frequent and a three-fold increase in the number of devices affected per advisory was observed. The number of devices affected by hardware advisories increased three-fold, due primarily to a 700-fold increase in electrical/circuitry abnormalities and a 20-fold increase in potential battery/capacitor malfunctions. Other types of hardware abnormalities (defects in the device header, hermetic seal, etc.) became less common. The number of devices recalled due to firmware (computer programming) abnormalities more than doubled. The remarkable technological advances in pacemaker and ICD therapy have been accompanied by changing patterns of device advisory type. Accurate, timely physician and patient notification systems, and routine pacemaker and ICD patient follow-up continue to be of paramount importance.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1046/j.1460-9592.2002.01670.x
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  • 5
    Electronic Resource
    Electronic Resource
    Identification and Ablation of Three Types of Ventricular Tachycardia Involving the His-Purkinje System in Patients with Heart Disease (2004)
    350 Main Street , Malden , MA 02148-5018 , USA , and 9600 Garsington Road , Oxford OX4 2DQ , UK . : Blackwell Science Inc
    Journal of cardiovascular electrophysiology 15 (2004), S. 0 
    Details
    ISSN: 1540-8167
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Introduction: Ventricular tachycardia (VT) with involvement of the His-Purkinje system (HPS) can be difficult to recognize in patients with heart disease, but it may be particularly susceptible to ablation targeting the HPS. This study defines the incidence and types of HPS involvement in VT. Methods and Results: Involvement of the HPS was sought during electrophysiologic study with catheter mapping in 234 consecutive patients referred for catheter ablation of recurrent VT associated with heart disease. HPS VT was observed in 20 (8.5%) patients (mean ejection fraction 29%± 17%); in 9 (11%) of 81 patients with nonischemic heart disease and 11 (7.1%) of 153 patients with coronary artery disease (P = NS). Three types of HPS VT were observed: 16 patients (group 1) had typical bundle branch reentry, 2 patients (group 2) had bundle branch reentry and interfascicular reentry, and 2 patients (group 3) had VT consistent with a focal origin in the distal HPS. In all three groups, the VT QRS had morphologic similarity to the sinus rhythm QRS. Ablation of HPS VT was successful in all patients in whom it was attempted but produced high-degree AV block in 6 (30%). In 12 patients (60%), other VTs due to reentry through scar also were inducible. Conclusion: Involvement of the HPS in VT associated with heart disease has three distinct clinical forms, all of which are susceptible to ablation. Ablation often is not sufficient as the sole therapy due to other induced VT's and conduction abnormalities, requiring pacemaker and/or defibrillator implantation. (J Cardiovasc Electrophysiol, Vol. 15, pp. 52-58, January 2004)
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1046/j.1540-8167.2004.03189.x
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  • 6
    Electronic Resource
    Electronic Resource
    Identification of Left Atrial Origin of Ectopic Tachycardia During Right Atrial Mapping: (2000)
    Oxford, UK : Blackwell Publishing Ltd
    Journal of cardiovascular electrophysiology 11 (2000), S. 0 
    Details
    ISSN: 1540-8167
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Left Atrial Ectopic Tachycardia. Introduction: The high posteromedial right atrium is adjacent to the left atrium near the right superior pulmonary vein. We hypothesized that analysis of electrograms at this site could distinguish left from right atrial tachycardia. Methods and Results: Atrial mapping was performed in 16 patients with left atrial origin ectopic tachycardia (11 patients with right superior pulmonary vein origin and 5 patients with other left atrial tachycardias). During left atrial tachycardia, earliest right atrial activation was recorded at the high posterior right atrium in 14 of 16 patients. At all of these 14 early sites, double potentials were recorded during tachycardia. The first potential was a far-field signal from left atrium as indicated by the following: (1) during sinus heats, the timing of the two potentials reversed such that the left atrial one was late; (2) ablation at the right atrial site did not decrease the amplitude of the first potential, but did decrease the amplitude of the second potential; and (3) the timing of activation at the adjacent left atrium agreed with that of the first potential. In the 11 right superior pulmonary vein tachycardias, the first potential was markedly earlier than the p wave onset, but in left atrial tachycardias with other origins it was later. In a control group of six patients with pacing to simulate right atrial tachycardia, double potentials were recorded In the posterior right atrium, but the timing of components did not reverse during sinus rhythm. Conclusion: For some left atrial ectopic tachycardias, particularly those originating from the right superior pulmonary vein, recognition of left versus right atrial origin can be accomplished during right atrial mapping by analysis of double potentials in the posteromedial right atrium.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1540-8167.2000.tb00169.x
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  • 7
    Electronic Resource
    Electronic Resource
    Mapping and Radiofrequency Catheter Ablation of the Three Types of Sustained Monomorphic Ventricular Tachycardia in Nonischemic Heart Disease (2000)
    Oxford, UK : Blackwell Publishing Ltd
    Journal of cardiovascular electrophysiology 11 (2000), S. 0 
    Details
    ISSN: 1540-8167
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Ventricular Tachycardia Ablation, Introduction. Sustained monomorphic ventricular tachycardia (VT) associated with nonischemic cardiomyopathy (CMP) is uncommon. Optimal approaches to catheter mapping and ablation are not well characterized, but they are likely to depend on the VT mechanism. The purpose of this study was to evaluate the mechanisms of sustained monomorphic VT encountered in nonischemic CMP and to assess the feasibility, safety, and efficacy of catheter radiofrequency ablation for treatment. Methods and Results: Twenty-six consecutive patients with nonischemic CMP referred for management of recurrent VT were studied. In 16 (62%) patients, VT was related to a region of abnormal electrograms consistent with scar and the response to pacing suggested a reentrant mechanism. In 5(19%) patients, VT was due to bundle branch or interfascicular reentry. In 7(27%) patients, the VT mechanism was focal automaticity, 4 of whom had evidence of tachycardia-induced CMP. After catheter ablation targeting parts of reentrant circuits, VT was not inducible in 8 (53%) of 15 patients with scar-related reentry, was modified in 5(33%) patients, and still was inducible in 2(13%) patients. Ablation was successful in 5 of 5 patients with bundle branch reentry and in 6 of 7 patients with a focal automaticity mechanism. Overall, catheter ablation abolished clinical recurrence of VT in 20 (77%) of 26 patients during a follow-up of 15 ± 12 months. Conclusion: Three different mechanisms of VT are encountered in patients with nonischemic CMP. The mapping and ablation approach varies with the type of VT. In this selected population, the overall efficacy was 77%.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1540-8167.2000.tb00728.x
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  • 8
    Electronic Resource
    Electronic Resource
    Esmolol and Other Intravenous Beta-Blockers (2000)
    Springer
    Cardiac electrophysiology review 4 (2000), S. 240-242 
    Details
    ISSN: 1573-725X
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1023/A:1026587213876
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    Paper (German National Licenses)
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  • 9
    Electronic Resource
    Electronic Resource
    Esmolol and Other Intravenous Beta-Blockers (1998)
    Springer
    Cardiac electrophysiology review 2 (1998), S. 170-172 
    Details
    ISSN: 1573-725X
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1023/A:1009915629815
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    Paper (German National Licenses)
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