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  • 1
    ISSN: 1540-8167
    Quelle: Blackwell Publishing Journal Backfiles 1879-2005
    Thema: Medizin
    Notizen: Autonomic Control of the AV Node. Introduction: Following radiofrequency catheter ablation of AV nodal reentrant tachycardia (AVNRT), inappropriate sinus tachycardia may occur, possibly due to damage to autonomic cardiac nerve fibers. Furthermore, inducibility of AVNRT is often critically dependent on the autonomic balance. We investigated whether successful ablation of AVNRT is associated with an alteration of autonomic input to the sinus and AV nodes. Methods and Results: To estimate changes in the automatic modulation of the sinus and AV nodes, power spectra of beat-to-beat PP and PR intervals were analyzed from high-quality nighttime ECG recordings of 11 patients before and after radiofrequency application. Normalized HF power (nHF) of PP and PR intervals was used as an index of efferent vagal modulation and the LF/HF ratio as an index of sympathovagal balance of the sinus node (PP) and AV node (PR). Before ablation, LF/HFPP was 3.2 and nHFPP was 0.3 in the sinus node, For the A/V node, LF/HFPR was 1.2 and nHFPR was 0.5. Following ablation. LF/HFPP (3.5) and nHFPP (0.3) of the PP intervals did not change. Similarly to the sinus node, there were no changes in the autonomic modulation of the AV node, as both LF/HFPR (1.2) and nHFPR (0.5) remained unchanged. Conclusion: Our results indicate that autonomic control of the sinus und AV nodes is preserved following successful radiofrequency ablation of AVNRT. The effects of posteroseptal radiofrequency current application are not necessarily mediated by changes in the autonomic input to the AV node.
    Materialart: Digitale Medien
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  • 2
    Digitale Medien
    Digitale Medien
    Oxford, UK : Blackwell Publishing Ltd
    Journal of cardiovascular electrophysiology 11 (2000), S. 0 
    ISSN: 1540-8167
    Quelle: Blackwell Publishing Journal Backfiles 1879-2005
    Thema: Medizin
    Notizen: Autonomic Modulation of Sinus Node and Ventricle. Introduction. The aim of this study was to investigate whether autonomic modulation of ventricular repolarization may spontaneousiy differ from that of the sinoatrial node.Methods and Results. Onset of P waves. QRS complexes, and the apex and end of T waves were detected heat to heat in high-resolution ECGs from nine healthy young men during the night. There were time-dependent fluctuations in the QT/RR slopes of consecutive 5-minute segments that could not he explained by the mean RR cycle length of the respective segment. Because the variahility found in QT intervals could not be explained hy either possible effects of rate dependence or hysteresis, autonomic effects were obvious. Power speetral analysis was performed for consecutive 5-minute segments of PP and QT techograms. In a given subject. trends in the time course of low-frequency (LF) and high-frequency (HF) power in PP and QT often were similar, but they were quite different at other times. The mean LF/HF ratio for QTend (0.75 ± 0.1) was different from that of PP (1.8 ± 0.2; P = 0.002), indicating differences in sympathovagal balance at the different anatomic sites. Furthermore, at a given mean heart rate, averaged QT intervals were different on a time scale of several minutes to hours. The QT/RR slope of 5-minute segments correlated significantly with the HF power of QT variability but not with that of PP variability, indicating effects of the autonomic nervous system on ventricular action potential restitution.Conclusion. These differences demonstrate that changes in sinus node automaticity are not necessarily indicative of the autonomic control of ventricular myocardium. (J Cardiavasc Electrophysiol, Vol. II, pp. 1063-1070. October 2000)
    Materialart: Digitale Medien
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  • 3
    Digitale Medien
    Digitale Medien
    Oxford, UK : Blackwell Publishing Ltd
    Journal of cardiovascular electrophysiology 9 (1998), S. 0 
    ISSN: 1540-8167
    Quelle: Blackwell Publishing Journal Backfiles 1879-2005
    Thema: Medizin
    Notizen: Body Surface Potentials During ICD Discharge. Introduction: Little is known about the hazard for persons in contact with patients experiencing a high-voltage discharge of their implantable cardioverter defibrillator (ICD). Compared to epicardial systems, this risk may be increased with transvenous electrode systems and particularly in active can configurations.Methods and Results: In 23 patients with a transvenous active can ICD system, body surface potentials VS and current through an external resistance were measured during 35 discharges. VS was detected using skin electrodes positioned over the left subpectorally implanted pulse generator [C], apex of the heart [A], and the right pectoral region [RP]. Mean VS during discharges without an external shunt resistance ranged between 13 and 63.8 V [C to A] and 12.5 to 47.3 V [C to RP] (ICD peak stored/output voltage Vcap= 183 to 606 V, n = 20). Mean current flow [C to A] was 8.2 to 46.8 mA (Vcap= 288 to 633 V. n = 10) and 42 to 120.7 mA (Vcap= 447 to 579 V, n = 5) across a resistance of 1.696 and 797 ω, respectively.Conclusion: During high-output shocks, a considerable potential difference is present on the hody surface of ICD patients that, according to the literature, may induce a single cardiac response in a bystander. Analogous to spontaneous extrasystoles, there is only a minimal chance of triggering a tachyarrhythmia by this stimulated extra beat. Direct induction of ventricular fibrillation is unlikely, since reported fibrillation threshold values are much higher than the ohserved magnitudes of current and voltage.
    Materialart: Digitale Medien
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  • 4
    Digitale Medien
    Digitale Medien
    Oxford, UK : Blackwell Publishing Ltd
    Journal of cardiovascular electrophysiology 6 (1995), S. 0 
    ISSN: 1540-8167
    Quelle: Blackwell Publishing Journal Backfiles 1879-2005
    Thema: Medizin
    Notizen: Autonomic Modulation of Sinus and AV Nodes. Introduction: Evidence from animal experiments indicates that the autonomic nervous system may influence the sinus (SA) and atrioventricular (AV) nodes differently. We investigated, therefore, whether there are spontaneous functional differences in the innervation of the SA and AV nodes in man. Methods and Results: This study was performed in 10 healthy males (ages 21 to 26 years) during strict bed rest from 10 pm to 6 am. Three ECG leads were digitized on-line. PR and PP intervals were determined on a heat-to-beat basis off-line using a correlation algorithm with an accuracy of ± 2 msec and were verified visually. During; major body movements, there were sudden decreases in PP intervals of 36 to 827 msec (mean 335) for periods of 6 to 265 seconds (mean 24), During these phases of heart rate (HR) acceleration, PR intervals showed either concomitant shortening (9 to 30 msec), no change, or lengthening (6 to 25 msec). Furthermore, tonic changes in the PR interval occurred over 15-minute periods during which the range of PP intervals was constant. Additionally, recovery-adjusted PR interval (PR - b2/RP) and cycle length were negatively correlated for some periods, which confirmed independent autonomic effects on SA node and A V node. Conclusion: Beat-to-beat measurement of PR intervals allows for evaluation of autonomic effects on the human AV node. The different patterns in PR intervals during sudden spontaneous increases in HR and the tonic changes in PR interval indicate that the autonomic inputs to the SA and AV nodes are, in principle, independent of each other.
    Materialart: Digitale Medien
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  • 5
    ISSN: 1540-8167
    Quelle: Blackwell Publishing Journal Backfiles 1879-2005
    Thema: Medizin
    Notizen: Inappropriate Discharge of an ICD. Introduction: Inappropriate discharses of an implantable cardioverter defibrillator (ICD) are troublesome to the patient and sometimes a difficult task for the physician trying; to identify and treat the cause. Methods and Results: For the first time, we report a mechanism of inappropriate ICD discharges during episodes of atrail flutter with a slow ventricular response and intermittent antibradycardia pacing. The episodes occurred in tow patients and were triggered by the unique sensing alogorithm of the Ventitex Cadence® V-100 in combination with the tripolar CPI Endotak® 072 transvenous defibrillation lead, which provides integrated bipolar sensing. Conclusion: Besides treatment of the underlying arrhythmia, reprogramming of the device, an electrode position far away from the atria, and true bipolar sensing will enhance the performance of ICD systems with respect to the episodes described here. In addition, more flexible sensing algorithms may. in the future, prevent this overall rare complication.
    Materialart: Digitale Medien
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  • 6
    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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  • 7
    ISSN: 1432-0770
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Biologie , Informatik , Physik
    Notizen: Abstract Counting statistics in the form of the variance-time curve provides an alternative to spectral analysis for point processes exhibiting 1/f β-fluctuations, such as the heart beat. However, this is true only for β〈1. Here, the case of general β is considered. To that end, the mathematical relation between the variance-time curve and power spectral density in the presence of 1/f β-noise is worked out in detail. A modified version of the variance-time curve is presented, which allows us to deal also with the case β⩾1. Some applications to the analysis of heart rate variability are given.
    Materialart: Digitale Medien
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  • 8
    ISSN: 1432-0770
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Biologie , Informatik , Physik
    Notizen: Abstract.  Counting statistics in the form of the variance-time curve provides an alternative to spectral analysis for point processes exhibiting 1/ f  β-fluctuations, such as the heart beat. However, this is true only for β〈1. Here, the case of general β is considered. To that end, the mathematical relation between the variance-time curve and power spectral density in the presence of 1/ f  β-noise is worked out in detail. A modified version of the variance-time curve is presented, which allows us to deal also with the case β?1. Some applications to the analysis of heart rate variability are given.
    Materialart: Digitale Medien
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  • 9
    ISSN: 1432-0770
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Biologie , Informatik , Physik
    Notizen: Abstract 1/f fluctuations in heart rate are usually measured by spectral analysis using Fast Fourier Transform. Here, we introduce a new method based on counting the number of QRS complexes in time intervals Δt of various length. For a 1/f b spectrum the variance of counts in Δt follows a power-law as gDt 1+b. This method is applied to analyze long term fluctuations in heart rate variability in 10 healthy men. The results show periods of 1/f fluctuations with interpolated periods of white noise during night hours.
    Materialart: Digitale Medien
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  • 10
    Digitale Medien
    Digitale Medien
    Springer
    Cardiac electrophysiology review 1 (1997), S. 338-342 
    ISSN: 1573-725X
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Materialart: Digitale Medien
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