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  • 1
    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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  • 2
    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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  • 3
    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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  • 4
    Electronic Resource
    Electronic Resource
    Morphology Discrimination: A Beat-to-Beat Algorithm for the Discrimination of Ventricular from Supraventricular Tachycardia by Implantable Cardioverter Defibrillators (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: 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.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1046/j.1460-9592.2001.01519.x
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  • 5
    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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  • 6
    Electronic Resource
    Electronic Resource
    Rezidivierende Synkopen unklarer Genese Diagnostik mittels implantierbaren “Loop”-Recorders (2000)
    Springer
    Medizinische Klinik 95 (2000), S. 578-582 
    Details
    ISSN: 1615-6722
    Keywords: Schlüsselwörter Synkope ; Diagnostik ; “Loop”-Recorder ; Key Words Syncope ; Diagnosis ; Loop recorder
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract Background: In about a third of cases of recurrent syncope a diagnosis cannot be established despite extensive cardiovascular and neurologic testing. In patients without underlying heart disease the sensitivity of conventional diagnostic testing is low. Case Report: A 33-year-old male patient underwent implantation of a loop recorder (Reveal®) after negative neurological and cardiovascular testing. One month after implantation sinus node arrest could be documented during a presyncope. The patient underwent pacemaker implantation and remains asymptomatic since then. Conclusion: In patients with syncope and a negative conventional diagnostic workup the implantable loop recorder is a helpful and cost-effective diagnostic tool.
    Notes: Zusammenfassung Hintergrund: Die Diagnostik rezidivierender Synkopen bleibt trotz neurologischer und invasiver kardiologischer Befunderhebung in etwa einem Drittel der Fälle ohne Ergebnis. Insbesondere bei Patienten ohne kardiale Grundkrankheit und ohne Hinweise auf ein Anfallsleiden sind konventionelle diagnostische Methoden wenig sensitiv. Falldarstellung: Einem 33jährigen Patienten mit rezidivierenden Synkopen und umfangreicher negativer neurologischer und kardiologischer Diagnostik wurde ein “Loop”:-Recorder (Reveal®) implantiert. Bereits einen Monat nach Implantation konnte im Rahmen einer Präsynkope ein Sinusarrest mit 3,7 Sekunden Pause aufgezeichnet werden. Daraufhin wurde die Indikation zur Schrittmacherimplantation gestellt, und der Patient ist seitdem symptomfrei. Schlußfolgerung: Bei negativer Synkopendiagnostik stellt der implantierte “Loop”-Recorder eine wertvolle und kosteneffektive Untersuchungsmethode dar.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/PL00002065
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