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  • 1
    Electronic Resource
    Electronic Resource
    Electrophysiologic Characteristics of Accessory Atrioventricular Connections in an Inherited Form of Wolff-Parkinson-White Syndrome (1999)
    Oxford, UK : Blackwell Publishing Ltd
    Journal of cardiovascular electrophysiology 10 (1999), S. 0 
    Details
    ISSN: 1540-8167
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: EP Characteristics in Familial WPW. Introduction: A familial form of Wolff-Parkinson-White syndrome (WPW) occurs in association with hypertrophic cardiomyopathy and intraventricular conduction ahnormalities. This syndrome, demonstrating autosomal dominant inheritance and segregating with a high degree of penetrance but variable expressivity, has been genetically linked to chromosome 7q3. The purpose of this study is to detail the electrophysiologic characteristics of accessory atrioventricular connections (AC) in four members of a kindred with this syndrome. Methods and Results: We clinically evaluated 32 members of a single kindred and identified 20 individuals with ventricular preexcitation, abnormal intraventricular conduction including complete AV block and/or ventricular hypertrophy, Genetic linkage analysis mapped the disease gene in this kindred to the chromosome 7q3 locus (maximum logarithm of the odds score = 6.88, θ= 0); recombination events in affected individuals reduced the genetic interval from 7 centimorgans (cM) to 5 cM. Electrophysiologic study of four individuals with preexcitation, identified seven AC (1 right sided, 3 septal, and 3 left sided). All four individuals had inducible orthodromic tachycardia; while three had multiple AC. Bidirectional conduction was demonstrated in 6 of 7 AC. Successful ablation was accomplished in 5 of 7 AC. Conclusion: The electrophysiologic characteristics and location of AC in family members having this complex cardiac phenotype are similar to those seen in individuals with isolated WPW. Identification of WPW in more than one family member should prompt clinical evaluation of relatives for additional findings of ventricular hypertrophy or conduction abnormalities.(J Cardiovasc Electrophysiol. Vol. 10, pp. 629-635, May 1999)
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1540-8167.1999.tb00239.x
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  • 2
    Electronic Resource
    Electronic Resource
    Safety of Nurse-Administered Deep Sedation for Defibrillator Implantation in the Electrophysiology Laboratory (1996)
    Oxford, UK : Blackwell Publishing Ltd
    Journal of cardiovascular electrophysiology 7 (1996), S. 0 
    Details
    ISSN: 1540-8167
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: ICD and Sedation. Implantation of implantable cardioverter defibrillators (ICDs) in the electrophysiology (EP) laboratory has been shown to be safe. However, general endotracheal anesthesia and/or administration of sedatives is mostly performed by anesthesiologists. In 53 patients undergoing ICD implantation in the EP laboratory, we prospectively assessed whether deep sedation without endotracheal intubation can be administered by nursing personnel under medical supervision. The mean patient age was 67 ± 7 years, and the mean ejection fraction was 32 ± 8%. All ICDs were placed in the abdomen requiring lead tunneling. Patients were monitored with pulse oximetry and noninvasive blood pressure recordings. The level of consciousness and vital signs were evaluated at 5-minute intervals. Deep sedation was induced with phenergan and midazolam and maintained with either meperidine or fentanyl. The mean doses given were as follows: phenergan 0.33 ± 0.15 mg/kg, midazolam 0.05 ± 0.03 mg/kg, meperidine 0.46 ± 0.10 mg/kg per hour, and fentanyl 1.94 ± 0.71 μg/kg per hour. None of the patients required intubation during or after the procedure. No death occurred and no patient had any recollection of the procedure. In three patients, O2 desaturation was easily managed by transient reversion of the effects of meperidine or fentanyl with naloxone. No patient experienced prolonged hospitalization after the implant (mean 2.4 ± 0.5 days). In conclusion: (1) adequate sedation for ICD implantation and testing can be administered safely by nursing staff in the EP lab; (2) optimum sedation protocols should include drugs easy to reverse in case of excessive respiratory depression; and (3) this may represent a more cost-effective approach to ICD implantation.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1540-8167.1996.tb00531.x
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  • 3
    Electronic Resource
    Electronic Resource
    Evaluation of the Safety and Efficacy of Deep Sedation for Electrophysiology Procedures Administered in the Absence of an Anesthetist (1997)
    Oxford, UK : Blackwell Publishing Ltd
    Pacing and clinical electrophysiology 20 (1997), S. 0 
    Details
    ISSN: 1540-8159
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Several procedures performed in the electrophysiology laboratory (EP lab) require surgical manipulation and are lengthy. Patients undergoing such procedures usually receive general anesthesia or deep sedation administered by an anesthesiologist. In 536 consecutive procedures performed in the EP lab, we assessed the safety and efficacy of deep sedation administered under the direction of an electrophysiologist and in the absence of an anesthetist. Patients were monitored with pulse oximetry, noninvasive blood pressure recordings, and continuous ECGs. The level of consciousness and vital signs were evaluated at 5-minute intervals. Deep sedation was induced in 260 patients using midazolam, phenergan, and meperidine, then maintained with intermittent dosing of meperidine at the following mean doses: midazolam 0.031 ± 0.024 mg/kg; phenergan 0.314 ± 0.179 mg/kg; and meperidine 0.391 ± 0.167 mg/kg per hour. In the remaining 276 patients, deep sedation was induced with midazolam and fentanyl and maintained with a continuous infusion of fentanyl at a mean dose of 2.054 ± 1.43 μg/kg per hour. Fourteen patients experienced a transient reduction in oxygen saturation that was readily reversed following administration of naloxone. An additional 11 patients desaturated secondary to partial airway obstruction, which resolved after repositioning the head and neck. Fourteen patients experienced hypotension with fentanyl. All but one returned to baseline blood pressures following an infusion of normal saline. No patient required intubation and no death occurred. Only three patients had recollection of periprocedure events. No patient remembered experiencing pain with the procedure. Hospital stays were not prolonged as a result of the sedation used. In conclusion: (1) deep sedation during EP procedures can be administered safely under the guidance of the electrophysiologist without an anesthetist present; (2) the drugs used should be readily reversible in case of respiratory depression; and (3) this approach may reduce the overall cost of the procedures in the EP lab, maintaining adequate patient comfort.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1540-8159.1997.tb03571.x
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    Paper (German National Licenses)
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