Safety of external cardioversion/defibrillation in patients with internal defibrillation patches and no device.

Placement of prophylactic epicardial defibrillation patches at time of open-heart surgery in patients at risk for postoperative arrhythmias has been strongly questioned. Concern has centered on the ability to safely perform subsequent external defibrillation if needed. From 61 patients who were treated with a two-stage strategy we identified 17 who, while wearing epicardial patches and no generator, received external cardioversion/defibrillation for 20 episodes of hemodynamically unstable ventricular arrhythmias.

The effects of percutaneous catheter ablation on preexisting permanent pacemakers.

Study Objective: Determine the effect of percutaneous catheter ablation (CA) on permanent pacemakers.

Measurements And Results: Twenty-three patients who underwent CA at The Cleveland Clinic Foundation from September 1983 to January 1990, and had a previously implanted pacemaker were studied. Electrocardiographic data during the CA procedure and clinic data including pacemaker evaluations were analyzed.

Breathing at birth and the associated blood gas and pH changes in the lamb.

We examined the relationship between the initiation of breathing at birth and the timing of delivery of the chest in a group of 13 lambs undergoing spontaneous unassisted delivery at term. In 8 of 11 lambs with a diaphragm electromyogram or intrapleural pressure signal the first breath occurred before chest delivery. The first breath was always followed by a period of irregular and often powerful inspiratory efforts.

Vasovagal syncope: diagnostic role of head-up tilt test in patients with positive ocular compression test.

We investigated the relative merits of the ocular compression test and the head-up tilt test to aid differentiation of syncope and seizures in young patients. Sixteen patients (10 males and 6 females) with a mean age of 14 +/- 4.7 (SD) years (range 7-22 years) underwent graded head-up tilt (15 degrees, 30 degrees, and 45 degrees for 2 minutes each, then 60 degrees for 20 minutes) following positive ocular compression testing defined as precipitation of asystole for at least 3 seconds (mean 5 seconds +/- 2 seconds, range 3-12 seconds).

Infections in implantable cardioverter defibrillator patients.

Implantable cardioverter defibrillators (ICDs) have been documented as an effective modality in reducing arrhythmic mortality. A serious complication associated with implantation of the device is infection. Few studies have addressed this issue.

Chronic transvenous pacemaker lead removal using a unique, sequential transvenous system.

Transvenous removal of 43 consecutive chronic pacemaker leads was successful in 28 patients. For leads not removed by traction at the pacemaker connection terminal, a unique locking stylet was advanced through the inner coil lumen and engaged at the tip to allow traction without lead elongation. Leads not extracted with the locking stylet alone had traction maintained on the stylet as sheaths were advanced over the lead to dilate and detach any fibrous tissue adherent to the lead.

Serial electrophysiologic testing of drug therapy in supraventricular tachycardia related to accessory pathways.

Data are limited on the use of serial electrophysiologic testing of drug therapy in patients with supraventricular tachycardia associated with accessory pathways, including the Wolff-Parkinson-White syndrome. Twenty-four highly symptomatic patients (aged 36 +/- 11 years) with SVT related to accessory pathways underwent electrophysiologic studies to select an effective chronic oral treatment. Conventional (verapamil, propranolol, quinidine, disopyramide) and investigational (amiodarone, aprindine, propafenone) drugs were used alone and in combination if necessary.

Patient and spouse acceptance and adaptation to implantable cardioverter defibrillators.

Although electrophysiologic devices have been available since 1932 for managing sudden cardiac death, it was not until 1980 that the predecessor to the automatic implantable cardioverter defibrillator was introduced. Subsequently, questions about psychosocial adaptation have prevented wide acceptance of these devices. To study this issue, 69 patients with treatment-resistant ventricular arrhythmias were sent a questionnaire following cardioverter implantation; spouses also received questionnaires.

Atrial pacemaker leads compared.

In order to analyze the impact of different polarity and electrode designs on the acute pacing and sensing characteristics of pacemaker leads, 80 patients with complete heart block or sinus node dysfunction undergoing pacemaker implantation received eight different leads from five manufacturers. Once the leads were positioned, volt and current thresholds, P wave, peak-to-peak, and slew rate were assessed prospectively. There was no statistically significant difference between acute pacing thresholds, sensing characteristics, or unipolar and bipolar pacing thresholds.

Adenosine: a new drug for acute termination of supraventricular tachycardia.

Adenosine, recently released for the acute termination of supraventricular tachycardia, is potentially the drug of first choice for this indication. Its notable effects are transient slowing of the sinus rate and atrioventricular nodal block. Adverse effects are transient and clinically insignificant, primarily because of the ultra-short half-life of the drug.

Pacemaker and defibrillator combination therapy for recurrent ventricular tachycardia.

The judicious use of antitachycardia pacemakers can enhance the benefits of automatic implantable cardioverter defibrillators in certain patients. Both devices were implanted in 10 highly selected patients with drug-refractory pace-terminable sustained ventricular tachycardia. During the observation period of 8 +/- 4.

Potassium loading as adjunct treatment of repetitive ventricular arrhythmias.

To evaluate potassium supplementation as adjunct therapy for ventricular arrhythmias, consecutive normokalemic patients undergoing in-hospital antiarrhythmic therapy for ventricular tachycardia were randomly assigned to one of four groups: intravenous potassium chloride (Group I, 44 patients) v intravenous saline (Group II, 48 patients); and oral potassium chloride capsules (Group III 50 patients) v no additional treatment (Group IV, 47 patients). All groups underwent serial serum potassium determinations and 24-hour electrocardiographic monitoring. Analysis revealed no significant differences in ventricular ectopic activity among groups, and there was no significant association between serum potassium level and incidence of ventricular arrhythmias.

High-performance liquid chromatographic determination of isepamicin in plasma, urine and dialysate.

A high-performance liquid chromatographic method for the measurement of isepamicin, a new aminoglycoside, in plasma, urine and dialysate is reported. The assay utilizes a simple extraction of isepamicin in plasma using commercially available Cyano solid-phase cartridges and dilution of urine and dialysate samples. The separation is performed on a Hypersil C18 column (15 cm X 4.

Morphometric study of the role of pulmonary arterial flow in fetal lung growth in sheep.

Pulmonary hypoplasia has been associated with absent or hypoplastic pulmonary artery in four cases in humans. Despite these reports, the effects of decreased pulmonary arterial flow on fetal lung growth have not been adequately studied. This study defines the effects of left pulmonary artery (LPA) ligation on fetal lung growth in sheep by comparing morphometrically determined pulmonary volumes from LPA-ligated, sham-operated, and un-operated control fetuses.

Repair of vaginal vault prolapse with abdominal sacropexy.

Ten women were treated for complete eversion of the vaginal vault with an abdominal sacropexy technique utilizing rectus fascia as graft material. The vault was suspended from the anterior sacral ligament by a strip of rectus fascia. Nine of ten patients had complete cure of the prolapse.

Continuous right ventricular volume assessment by catheter measurement of impedance for antitachycardia system control.

Current implantable defibrillators are unable to differentiate between hemodynamically stable and unstable arrhythmias. This may result in unnecessary high energy shocks during arrhythmias that are better managed with other interventions. This study assessed the efficacy of the impedance catheter in sensing relative volumetric changes in the right ventricle as a measure of the hemodynamic status during an arrhythmia.

The use of beep-o-grams in the assessment of automatic implantable cardioverter defibrillator sensing function.

Noninvasive assessment of sensing performance in the automatic implantable cardioverter defibrillator is limited by the absence of telemetry or memory functions. The adaptation of the electrophysiological test mode into a "beep-o-gram" recording, with simultaneous audible tones and a surface electrocardiogram, was used in the confirmation of sensing malfunction. Eleven of 13 recordings in patients with documented or clinically suspected inappropriate defibrillator discharges (group 1) demonstrated evidence of definite oversensing.

Preexcitation syndromes: surgical ablation therapy. The Cleveland Clinic experience.

Thirty-four patients with preexcitation syndrome had surgical ablation of the accessory atrioventricular connection. All presented with sustained symptomatic arrhythmias, which had resulted in syncope in seven patients and aborted sudden cardiac death in four. Arrhythmias induced at electrophysiologic evaluation included orthodromic reciprocating tachycardia in 32 patients, antidromic reciprocating tachycardia in five patients, and atrial fibrillation in 29 patients.

Measurement of lung water dynamics and lung aeration in the perinatal period by use of digital X-ray fluoroscopy.

A method has been developed for the measurement of lung water dynamics and regional aeration of the lung in anesthetized newborn lambs by use of X-ray fluoroscopy, video recording, and digital image processing. After cesarean section and before the first breath fetal lambs under halothane-oxygen were placed on an X-ray table and connected to a volume-cycled respirator. X-ray fluoroscopy commenced before the initiation of respiration, and the images were recorded on video tape.

An evolutionary link for developing mammalian lungs.

Lungs of the human infant and those of other mammals are filled with fluid immediately prior to birth. Studies of the ionic composition of this fluid indicate that active ionic transport processes occur in the epithelial cells of the potential airspaces. The purpose of this study was to see if these active ion pumps were present in developing species other than mammals thus providing a possible evolutionary link to mammals.

The usefulness of amiodarone in management of refractory supraventricular tachyarrhythmias.

The efficacy of amiodarone was evaluated in 85 patients with supraventricular tachycardia (SVT) refractory to several antiarrhythmic agents (mean 3.8 +/- 1.0).

Analysis of amikacin-resistant Pseudomonas aeruginosa developing in patients receiving amikacin.

During a 36-month period, 28 patients treated for infections due to amikacin-susceptible Pseudomonas aeruginosa subsequently developed infections or colonization with amikacin-resistant P aeruginosa at the same site. Eleven amikacin-susceptible/-resistant pairs of isolates were analyzed for aminoglycoside-inactivating enzymes, plasmid profiles, cellular proteins, outer membrane proteins (OMPs), lipopolysaccharide (LPS) profiles, and amikacin uptake. While clearly distinct from isolates of other patients, sensitive and resistant isolates from the same patients were indistinguishable in plasmid profile, LPS profiles, and OMPs.

Lungs of the gecko Rhacodactylus leachianus (Reptilia: Gekkonidae): a correlative gross anatomical and light and electron microscopic study.

The lungs of the New Caldeonian gecko Rhacodactylus leachianus were examined by means of gross dissection and light and electron microscopy. This tropical species, which is the largest living gecko, possesses two simple, single-chambered lungs. Right and left lungs are of similar size and shape.