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  • 1
    Digitale Medien
    Digitale Medien
    Conversion of Recent-Onset Atrial Fibrillation to Sinus Rhythm: Effects of Different Drug Protocols (1998)
    Oxford, UK : Blackwell Publishing Ltd
    Pacing and clinical electrophysiology 21 (1998), S. 0 
    Details
    ISSN: 1540-8159
    Quelle: Blackwell Publishing Journal Backfiles 1879-2005
    Thema: Medizin
    Notizen: In a population of 417 hospitalized patients, the efficacy and safety of different drug regimens administered to convert atrial fibrillation (AF) of recent anset (≤ 7 days duration) to sinus rhythm were evaluated. All patients were in NYHA Class ≤ 2, and free of heart failure. They were randomly allocated to treatment with placebo in 121 patients; IV amiodarone, 5 mg/kg bolus, followed by 1.8 g/24 hours in 51 patients; IV propafenone, 2 mg/kg bolus, followed by 0.0078 mg/kg/min in 57 patients; p.o. propafenone, 600 mg p.o. in a single dose in 119 patients; and p.o. flecainide, 300 mg p.o. in a single dose in 69 patients. All patients were continuously monitored by Holter ECG, and the number of conversions to sinus rhythm was measured at 1, 3, and 8 hours. Results: (1) IV propafenone resulted in a higher conversion rate within 1 hour compared with the oral loading regimens of propafenone or flecainide, but the conversion rates at 3 and 8 hours were comparable, approximately 75% at 8 hours; 2) IV amiodarone was not different from placebo until 8 hours when it was associated with 57% of conversions; (3) conversion to sinus rhythm at 8 hours was observed in 37% of the placebo treated patients. Serious adverse effects occurred in few patients: two patients treated with flecainide and one treated with IV propafenone experienced left ventricular decompensation; one patient treated with placebo and two treated with flecainide had atrial flutter with rapid ventricular response. In conclusion, single-dose, oral loading with propafenone or flecainide are acceptable alternatives to conventional drug regimens in selected hospitalized patients. In addition, the measure of a placebo effect is mandatory in studies of recent-onset AF.
    Materialart: Digitale Medien
    URL: http://dx.doi.org/10.1111/j.1540-8159.1998.tb01203.x
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  • 2
    Digitale Medien
    Digitale Medien
    Low Energy Internal Atrial Cardioversion in Atrial Fibrillation Lasting More Than a Year (1999)
    Oxford, UK : Blackwell Publishing Ltd
    Pacing and clinical electrophysiology 22 (1999), S. 0 
    Details
    ISSN: 1540-8159
    Quelle: Blackwell Publishing Journal Backfiles 1879-2005
    Thema: Medizin
    Notizen: The aim of this study was to evaluate the efficacy of low energy internal atrial cardioversion in restoring sinus rhythm (SR) in patients with chronic atrial fibrillation (AF) persisting 〉 1 year. Fifteen patients with chronic AF lasting 〉 1 year (from 13–48 months, mean 24 ± 13 months) were studied. R wave synchronized 3/3 ms biphasic shocks were delivered between right atrial and coronary sinus (left pulmonary artery in five patients) electrodes. Sedatives or anesthetics were administered only at the patient's request. Results: Stable SR was restored in 14 (93%)of 15 patients after shocks with a mean leading edge voltage of 377 ± 77 V (range 260–500) and a mean delivered energy of 7.3 ± 3.4 J (range 2.6–12.9). The procedure was performed without anesthesia in 6 (40%) patients. All successfully cardioverted patients were treated with flecainide, sotalol, or amiodarone. During a follow up of 7.7 ± 7.9 months (range 1–24) AF recurred in five (36%) patients. Three of five AF recurrences occurred within 3 days after conversion to SR. Conclusion: Internal low energy atrial cardioversion is highly effective in restoring SR even in patients with AF lasting 〉 1 year. The long-term results from the standpoint of freedom from AF recurrences, are satisfactory, although additional antiarrhythmic treatment is required, particularly in the first days after conversion.
    Materialart: Digitale Medien
    URL: http://dx.doi.org/10.1111/j.1540-8159.1999.tb00341.x
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  • 3
    Digitale Medien
    Digitale Medien
    Oral Loading with Propafenone: A Placebo-Controlled Study in Elderly and Nonelderly Patients with Recent Onset Atrial Fibrillation (1998)
    Oxford, UK : Blackwell Publishing Ltd
    Pacing and clinical electrophysiology 21 (1998), S. 0 
    Details
    ISSN: 1540-8159
    Quelle: Blackwell Publishing Journal Backfiles 1879-2005
    Thema: Medizin
    Notizen: The efficacy and safety of propafenone as an oral loading dose (600-mg single oral dose) in converting recent-onset atrial fibrillation (≤ 7 days duration) to sinus rhythm were evaluated in a single-blind, placebo-controlled study according to patients' age. Overall, 240 hospitalized patients, NYHA Class ≤ 2 without signs or symptoms of heart failure were enrolled: among patients aged ≤ 60 years, 55 were allocated to propafenone treatment and 59 to placebo, respectively, and among patients aged 〉 60 years, 64 were allocated to propafenone treatment and 62 to placebo, respectively. Results: In each age group, the likelihood of conversion to sinus rhythm was significantly greater after propafenone compared with plocebo at 3 and 8 hours. For patients aged ≤ 60 years, corresponding odd ratios were 3.78 (95% CI = 1.80–7.92, P = 0.04) at 3 hours and 4.74 (95% CI = 2.12–10.54, P = 0.02) at 8 hours; for patients aged 〉 60 years odd ratios were 5.03 (95% CI = 2.08–12.12, P = 0.02) at 3 hours and 6.75 (95% CI = 3.28–73.86, P = 0.01) at 8 hours, respectively. Logistic regression analysis showed that conversion to sinus rhythm within 3 hours was predicted by age ≤ 60 years (P = 0.0064) and by propafenone treatment (P 〈 0.0001), and conversion to sinus rhythm within 8 hours was predicted by age ≤ 60 years (P = 0.0467) and by propafenone treatment (P 〈 0.0001). The occurrence of adverse effects was observed in 14%-16% of propafenone treated patients and in 8% of placebo treated patients without significant differences according to age. In conclusion, in patients with recent-onset atrial fibrillation without signs of heart failure, propafenone as a single oral loading dose is effective. It is also effective in selected elderly subjects with a favorable safety profile. Moreover, spontaneous conversion to sinus rhythm appears to occur less frequently in elderly patients.
    Materialart: Digitale Medien
    URL: http://dx.doi.org/10.1111/j.1540-8159.1998.tb01202.x
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  • 4
    Digitale Medien
    Digitale Medien
    Sick sinus syndrome and diffuse impairment of the conduction system in a child: Successful pacing with a steroid eluting endocardial pacing lead (1992)
    Springer
    Pediatric cardiology 13 (1992), S. 44-47 
    Details
    ISSN: 1432-1971
    Schlagwort(e): Atrial flutter ; Atrioventricular block ; Pacemaker ; Sick sinus syndrome
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Summary A 9-year-old patient who had had a syncope was found to have atrial flutter in a resting electrocardiogram (ECG). Brief phases of sinus arrest had previously occurred after drug conversion to sinus rhythm. Structural heart disease was excluded by cardiac catheterization and angiography. Electrophysiologic study revealed a sick sinus syndrome, associated with diffuse impairment of the conduction system (supra-, infra-, and intrahisian block). Epimyocardial and an endocardial pacemaker implantation failed because of high stimulation threshold, after 3 years and 2 weeks, respectively. At the third implantation a steroid-eluting endocardial pacing lead was used and satisfactory pacing was still present 2 years later.
    Materialart: Digitale Medien
    URL: http://dx.doi.org/10.1007/BF00788230
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  • 5
    Digitale Medien
    Digitale Medien
    The effects of enoximone (MDL-17043) on forearm venous circulation in healthy volunteers and patients with heart failure (1987)
    Springer
    Heart and vessels 3 (1987), S. 146-151 
    Details
    ISSN: 1615-2573
    Schlagwort(e): Congestive heart failure ; enoximone ; Peripheral circulation
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Summary The effect of intravenous enoximone on forearm venous circulation was studied in ten healthy volunteers (group A) and in ten patients with NYHA class III–IV congestive heart failure (group B). Distensibility of the forearm capacitance vessels was assessed from pressure-volume curves by venous occlusion plethysmography using a mercury-in-rubber strain gauge. Three recordings each at 3-min intervals were obtained before the infusion and again 20 min after completion of the infusion. Venous volume changes (VV) at congesting pressures of 10, 20, and 30 mmHg before and after enoximone were compared. Forearm muscle blood flow was also measured by venous occlusion plethysmography; electrocardiogram, heart rate, and cuff blood pressure were recorded throughout. Enoximone at a dose of 1 mg/kg body weight was infused over 10 min through a peripheral vein in group A and via a central line in group B. In group A, the effect of the injection vehicle was also assessed. VV10, VV20, and VV30 did not differ from baseline values after enoximone in both groups A and B. The vehicle caused a small but significant degree of venoconstriction in group A (VV20, 2.64±0.9 to 2.48±0.83 ml/100 ml,P〈0.05; VV30, 3.47±1.27 to 3.33±1.20 ml/100 ml,P〈0.05), which could be explained by an acute response to local pain from the infusion. This effect was not evident following enoximone, perhaps as a result of its counterbalancing vasodilating action to venoconstriction induced by acute pain. Muscle blood flow increased in both groups (group A, 3.05±0.33 to 4.62±1.32 ml/100 ml/min,P〈0.01; group B, 2.33±0.93 to 3.13±0.95 ml/100 ml/min,P〈0.02) after enoximone and did not change in group A after vehicle (3.08±1.50 to 2.73±0.87,P—not significant). It is concluded that enoximone at the dose studied does not exert appreciable effects on the forearm venous system in normal subjects or in patients with heart failure.
    Materialart: Digitale Medien
    URL: http://dx.doi.org/10.1007/BF02058791
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  • 6
    Digitale Medien
    Digitale Medien
    Hemodynamic effects of felodipine in congestive heart failure (1987)
    Springer
    Cardiovascular drugs and therapy 1 (1987), S. 161-167 
    Details
    ISSN: 1573-7241
    Schlagwort(e): felodipine ; congestive heart failure ; vasodilators
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Summary The hemodynamic effects of increasing dosages of felodipine, a new calcium antagonist with selective vasodilator properties, were studied in 13 patients with chronic cardiac failure. A Swan-Ganz thermodilution catheter was positioned in the pulmonary artery and hemodynamic parameters were monitored from 9 am to 6 pm for five days. On the first and the fifth day patients received placebo (P) and on the second, third, and fourth day patients received felodipine 5, 10, and 20 mg, respectively. Symptom-limited exercise tests with a bicycle ergometer were performed on both days of P and on the fourth day. A marked reduction of systemic vascular resistance (SVR) and a significant increase of cardiac index without increments of heart rate (HR) were observed after felodipine at rest. A dose response effect could be demonstrated. During exercise a significant increment of cardiac index and decrease of pulmonary wedge pressure was observed after felodipine. Felodipine showed a potent vasodilator action on systemic circulation with significant changes on both stroke volume and filling pressures at rest and during exercise without side effects.
    Materialart: Digitale Medien
    URL: http://dx.doi.org/10.1007/BF02125469
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  • 7
    Digitale Medien
    Digitale Medien
    Felodipine in severe chronic congestive heart failure: Acute effects on central hemodynamics and regional blood flow distribution (1989)
    Springer
    Cardiovascular drugs and therapy 3 (1989), S. 903-911 
    Details
    ISSN: 1573-7241
    Schlagwort(e): felodipine ; congestive heart failure ; regional blood flow
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Summary In order to assess the effect of felodipine, a new calcium antagonist with vascular selectivity, on regional blood flow distribution at rest in chronic congestive heart failure, ten patients were studied during an acute test. Right heart catheterization allowed the evaluation of hemodynamic parameters; renal blood flow was calculated using paraamino-hippuric acid clearance; hepatic blood flow measurement was based on indocyanine green clearance; and limb blood flow was assessed with venous occlusion plethysmography. Blood samples were collected for the analysis of plasma catecholamines, renin, and aldosterone. All parameters were recorded in duplicate under basal conditions and after felodipine infusion. The infusion of felodipine induced a significant increase in cardiac index, stroke work index, and limb blood flow. Systemic and pulmonary arterial blood pressure, pulmonary wedge pressure, and systemic resistance underwent a significant decrease. The heart rate, pulmonary resistance, renal blood flow, and hepatic blood flow were not changed. In conclusion, felodipine was of benefit in congestive heart failure at rest in an acute test, acting through a marked decrease in vascular resistance and a consequent improvement in cardiac output and limb blood flow. No changes in renal and hepatic blood flow were observed.
    Materialart: Digitale Medien
    URL: http://dx.doi.org/10.1007/BF01869580
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  • 8
    Digitale Medien
    Digitale Medien
    Minimal effective concentration values of propafenone and 5-hydroxy-propafenone in acute and chronic therapy (1990)
    Springer
    Cardiovascular drugs and therapy 4 (1990), S. 281-287 
    Details
    ISSN: 1573-7241
    Schlagwort(e): antiarrhythmic therapy ; pharmacokinetics ; propafenone ; ventricular premature beats
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Summary We evaluated the antiarrhythmic efficacy and the minimal effective concentrations of propafenone and its metabolite 5-hydroxy-propafenone during a) acute intravenous infusion (1.5 mg/kg in bolus followed by 45 minutes infusion), b) an acute oral single-dose test (450 mg), and c) 14-day chronic therapy (300 mg tid) followed by a washout. Oxidative metabolism was assessed by a debrisoquine oral test in every patient. Eleven patients with stable ventricular premature beats (VPBs)≥300/hr and Lown class ≥ 3 completed the study. The main results emphasized a certain discrepancy between the clinical effect of the acute intravenous infusion (efficacy in 5 out of 11 patients) and of the acute oral test and chronic therapy (efficacy in 11/11), with a time lag of the ECG changes during the acute intravenous infusion. The minimal effective concentrations were lower after acute oral administration compared with chronic treatment both for propafenone (200±189 ng/ml vs. 492±530 ng/ml; p〈0.05) and for 5-hydroxy-propafenone (82±40 ng/ml vs. 149±80 ng/ml; p〈0.02). A linear correlation was demonstrated between drug/metabolite ratios of propafenone and debrisoquine, either after acute oral (r=0.91) or after chronic administration (r=0.84). The pharmacokinetics of propafenone was nonlinear and showed wide interindividual variations. In conclusion, a) the lower efficacy and delayed electrophysiologic effects of propafenone after intravenous administration suggest that longer infusion times are necessary for complete antiarrhythmic efficacy; b) the differences observed in the minimal effective concentrations of acute versus chronic oral therapy suggest the development of partial tolerance to propafenone during chronic treatment.
    Materialart: Digitale Medien
    URL: http://dx.doi.org/10.1007/BF01857646
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  • 9
    Digitale Medien
    Digitale Medien
    Effect of enoximone alone and in combination with metoprolol on myocardial function and energetics in severe congestive heart failure: Improvement in hemodynamic and metabolic profile (1993)
    Springer
    Cardiovascular drugs and therapy 7 (1993), S. 337-347 
    Details
    ISSN: 1573-7241
    Schlagwort(e): myocardial energetics ; congestive heart failure ; enoximone ; beta-adrenergic blockade ; metoprolol
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Summary The hemodynamic and myocardial metabolic effects of enoximone (phosphodiesterase III inhibitor), alone or in combination with metoprolol (beta-adrenergic blocker), were studied in patients with congestive heart failure. Ten patients (New York Heart Association Class III–IV) underwent right heart and coronary sinus catheterization, and parameters were assessed at basal condition, at peak enoximone response (mean intravenous loading dose=2.2 mg/kg), and after the combination with metoprolol (mean intravenous dose=8.5 mg). Heart rate tended to increase during enoximone administration (from 102±16 to 107±16 min−1, ns) and was reduced during enoximone plus metoprolol (to 88±15 min−1, p〈0.05 vs. basal). Cardiac index was increased during enoximone (from 2.2±0.2 to 3.8±0.5 1/min/m2, p〈0.05) and decreased during enoximone plus metoprolol (to 2.8±0.5 1/min/m2, p〈0.05 vs. enoximone). Mean pulmonary wedge pressure fell during enoximone and remained reduced during enoximone plus metoprolol (from 27±9 to 9±3 and to 13±4 mmHg, respectively, both p〈0.05). Myocardial oxygen consumption did not change during enoximone (from 27±8 to 25±13 ml/min, ns) and was reduced during enoximone plus metoprolol (to 19±8 ml/min, p〈0.05 vs. basal). Myocardial lactate extraction tended to be lower during enoximone and during enoximone plus metoprolol conditions (from 38±17% to 26±20% and to 29±24%, respectively), but no statistical significance was found. Myocardial efficiency was increased during enoximone and during enoximone plus metoprolol (from 9±3% to 15±6% and to 14±6%, respectively, both p〈0.05). Thus in patients with congestive heart failure enoximone improves hemodynamics and, in most cases, it does not influence energetics. The addition of metoprolol to enoximone reduces heart rate, cardiac index, and myocardial oxygen consumption without any other major changes, producing a more physiologic hemodynamic and metabolic profile.
    Materialart: Digitale Medien
    URL: http://dx.doi.org/10.1007/BF00880157
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  • 10
    Digitale Medien
    Digitale Medien
    Myocardial, coronary, and peripheral effects of xamoterol (ICI 118,587) in open-chest pigs (1989)
    Springer
    Cardiovascular drugs and therapy 3 (1989), S. 91-97 
    Details
    ISSN: 1573-7241
    Schlagwort(e): xamoterol ; noradrenaline ; beta receptors ; cardiac actions ; vascular effects ; coronary effect
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Summary The hemodynamic and coronary effects of increasing doses of xamoterol, a beta-adrenoceptor partial agonist, were assessed in an anesthetized pig preparation in which cardiovascular reflexes were abolished and sympathetic tone was modified by infusion of noradrenaline (NA). Xamoterol, in basal conditions, increased heart rate (HR) from 104±12 to 120±13 beats/min (p〈.001); systolic, diastolic, and mean blood pressure, respectively, from 77±8 to 103±17 mmHg (p〈.01), from 48±7 to 70±12 mmHg (p〈.01), and from 58±7 to 84±14 mmHg (p〈.01); left ventricular dP/dT max from 2098±564 to 4205±937 mmHg/sec (p〈.001); and systemic vascular resistance (SVR) from 1745±564 to 2270±739 dynes sec cm−5 (p〈.01). The increase in HR and dP/dT max brought about by xamoterol was about 37% and 56%, resectively, of the maximum increase produced by NA. At the highest level of sympathetic tone, xamoterol reduced HR from 148±11 to 122±11 beats/min (p〈.001) and no significant change was observed in dP/dT max. The increase in blood pressure and SVR induced by xamoterol was maintained at each level of sympathetic tone. On the contrary, SVR did not change after NA, as expected, since receptors were fully blocked. For a given inotropic effect, xamoterol and NA produced a similar increase in coronary blood flow and myocardial O2 consumption. In conclusion, the results indicate that, in the areflexic pig, xamoterol acts as a partial beta1-agonist, with a more potent positive inotropic than chronotropic effect in basal conditions. At the highest level of sympathetic tone, it does antagonize the chronotropic, but not the inotropic, effect of NA. Xamoterol increases peripheral resistance and blood pressure possibly through a beta2 vascular blocking action, and the increase in contractility induced by xamoterol is paralleled by an increase in myocardial O2 consumption. No direct effects on coronary circulation are observed.
    Materialart: Digitale Medien
    URL: http://dx.doi.org/10.1007/BF01881533
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