Measurement of right ventricular blood temperature during exercise as a means of rate control in physiological pacemakers.

Several biological parameters have been suggested for rate control in physiological pacemakers in the past. Up to now, measurements of central venous blood temperature have been mostly done on dogs. We studied central venous blood temperature and heart rate in 14 healthy volunteers under conditions of treadmill and bicycle exercise with different workloads.

Rate control of physiologic pacemakers by central venous blood temperature.

Heart rate and central venous blood temperature (CVT) were measured in 31 people with different exercise capacities by means of a thermistor integrated into a lead that was placed in the right ventricle. Bicycle ergometric and treadmill stress tests with increasing workloads were performed. The maximum increase in CVT with ergometric exercise was found to be 1.

Survival and follow-up after pacemaker implantation: a comparison of patients with sick sinus syndrome, complete heart block, and atrial fibrillation.

The number of patients receiving cardiac pacemakers for sick sinus syndrome (SSS) has increased considerably in recent years. The literature has suggested that patients with sick sinus syndrome have a shorter life expectancy with pacemaker therapy than patients with total heart block or atrial fibrillation. We studied the survival rate of 1,049 patients with complete heart block, 592 with sick sinus syndrome and 447 with atrial fibrillation.

Regulation of pacing rate by variations of mixed venous oxygen saturation.

Right ventricular oxygen saturation (SO2) may be an ideal sensor for determining the rate of an implanted pacemaker. In order to prove this hypothesis, the obtained signals were optimally analyzed; determinations of SO2 at rest and during exercise were made in healthy volunteers and in patients with pacemakers; and an algorithm was developed for varying pacing rate as a function of measured SO2. The results suggest that this method may be applicable to the long-term implantee.

[Echocardiographic study for optimizing therapy with physiologic heart pacemakers--the relevance of mitral valve motion].

The hemodynamic effects of the AV-intervals 50, 150 and 250 ms were studied in 19 patients with VDD pacemakers and compared to VVI stimulation and 12 normal individuals. LV dimensions and systolic and diastolic time intervals were measured with echo-phonoapexcardiography. The amplitude of LV-contraction, LV enddiastolic diameter, PEP, LVET and PEP/LVET significantly improved with physiological pacing when compared to VVI-stimulation.

[Cardiac arrhythmias and their clinical significance in mitral valve prolapse].

Among 160 patients with mitral-valve prolapse but no other illness there were 118 with cardiac arrhythmias. 30 had frequent or multifocal ventricular premature systoles, 21 had coupled ventricular extrasystoles, and seven had ventricular tachycardia. In six patients the prematurity index was under 1.

Antiarrhythmic activity of esmolol (ASL-8052)--a novel ultra-short acting beta-adrenoreceptor blocking agent.

In a single-blind, placebo-controlled study, esmolol was administered intravenously to 12 patients with chronic atrial fibrillation. Esmolol produced a significant dose-dependent decrease in the ventricular rate without conversion to normal sinus rhythm in any of the patients. For most patients, a correlation was observed between the blood levels of esmolol and reductions in heart rate.

[Results and prognosis following heart valve replacement].

786 patients who underwent cardiac valve replacement between 1965 and 1982 were followed up. Early mortality rate was 7,3% for the total observation period and decreased to 3,2% for the last four years. Patients with aortic valve replacement had better results in regard to their functional improvement as well as in their survival rate compared to those with mitral- or multiple valve replacement.

[Delayed atrial excitation following bifocal pacemaker stimulation].

A patient with drug-resistant ventricular tachycardia due to ischemic heart disease with severe left ventricular failure was successfully treated by the implantation of a DDD pacemaker system pacing at a rate of 90 beats/min (overdrive suppression). Additional therapy with high doses of beta-blockers was necessary. The ECG demonstrated a delay of 100 ms between atrial spike and p-wave.

[Survival and outcome after pacemaker implantation. Comparison of patients with sinus node syndrome, AV block and absolute bradyarrhythmia].

Survival chances of 2007 patients with pacemaker implantation were determined. For the group as a whole, five-year survival rate was 57%, ten-year survival rate 35%. The prognosis was significantly better in patients with sick-sinus syndrome than those with AV block or brady-arrhythmias.

An active optical sensor for monitoring mixed venous oxygen-saturation for an implantable rate-regulating pacing system.

Presently available physiologic pacing systems do not fully restore rate regulation, especially in respect to little or no atrial response to activity. Other biologic parameters, detected by sensors, may provide the physiologic responsiveness necessary to rate-regulating pacemakers. An optical sensor using mixed venous oxygen saturation may be the ideal parameter for such a pacing system.

Treatment of acute left heart failure using dobutamine and intraaortic counterpulsation. Animal experiments and first clinical experiences.

Ten anesthetized mongrel dogs had a left anterolateral thoracotomy; the left anterior descending coronary artery was then ligated. After 60 min five animals each were treated either with dobutamine (4 microgram/min/kg; for 10 min), or with dobutamine and intraaortic counterpulsation. Combined treatment of cardiogenic shock proved superior.

[Removal of infected entrapped pacemaker electrodes by continuous traction (author's transl)].

To remove an infected pacemaker system in order to control the infection is often difficult when there is extensive connective-tissue fixation of the electrode. Forced manual extraction may lead to severe complications. For this reason, operative removal, in certain circumstances involving cardiotomy under extracorporeal circulation, has been practised.

The very low birth weight infant after discharge from intensive care: anticipatory health care and developmental course.

Despite intensive research, the data available on the long-term effects of prematurity on development of the child have not led to clearcut conclusions, particularly when the investigations are based on infant or perinatal factors alone. Previous research does indicate that the infant is "at risk" through school age and that the parents' perception of the child and the harmony between the child and his environment are powerful determinants of outcome. The implications for medical care, however, are clear.

[Septicemia secondary to an infected pacemaker system: removal of the endocardial lead with the aid of extracorporeal circulation (author's transl)].

Right ventriculotomy with extracorporeal circulation was used for removal of an infected transvenous pacemaker electrode which was firmly attached to the myocardium in a patient with septicemia. Alternative methods and suggestions to prohibit electrode incarceration are discussed.