Multicenter registry to evaluate the efficacy of the NIROYAL stent in de novo or restenotic coronary stenosis.

The purpose of this registry was to document the safety and efficacy of elective deployment of the NIROYAL stent (Boston Scientific SCIMED, Maple Grove, Minnesota) in coronary arteries. This was a prospective, multi-center international registry. NIROYAL stents (9, 16, 25 and 32 mm-long) were manually crimped onto coronary balloons and deployed in de novo or restenotic lesions in 165 male and female patients with angina pectoris and a reference vessel diameter of 2.

Atypical Kawasaki syndrome: how many symptoms have to be present?

A 20 year old woman with acute myocardial infarction exhibited a huge aneurysm of the left main coronary artery that was occluded by a large intraluminal thrombus. After exclusion of other vascular or systemic diseases, atypical Kawasaki syndrome was diagnosed. Other major symptoms usually required for this diagnosis were absent.

Primary angioplasty versus thrombolysis in the treatment of acute myocardial infarction. ALKK Study Group.

This study investigates the hypothesis if primary angioplasty is superior to intravenous thrombolysis in the treatment of acute myocardial infarction (AMI). Small prospective randomized studies did not demonstrate a significant benefit regarding total mortality. A total of 14,980 patients with AMI were registered by "The 60-Minutes Myocardial Infarction Project," a prospective multicenter observational study: 210 of these patients were treated with primary angioplasty.

[Splenic infarction caused by paradoxical emboli in severe pulmonary hypertension].

History And Clinical Findings: A 55-year-old woman developed increasing shortness of breath and breath-independent pain in the left lower chest. 20 years previously she had had an episode of pulmonary embolism and 10 years previously a central venous thrombosis in the left eye. No cause of the increased thrombogenesis had been found.

Improved thrombolysis in acute myocardial infarction with front-loaded administration of alteplase: results of the rt-PA-APSAC patency study (TAPS).

Thrombolysis with recombinant tissue-type plasminogen activator (rt-PA) and anisoylated plasminogen streptokinase activator (APSAC) in myocardial infarction has been proved to reduce mortality. A new front-loaded infusion regimen of 100 mg of rt-PA with an initial bolus dose of 15 mg followed by an infusion of 50 mg over 30 min and 35 mg over 60 min has been reported to yield higher patency rates than those achieved with standard regimens of thrombolytic treatment. The effects of this front-loaded administration of rt-PA versus those obtained with APSAC on early patency and reocclusion of infarct-related coronary arteries were investigated in a randomized multicenter trial in 421 patients with acute myocardial infarction.

Differences between atrial single chamber pacing (AAI) and ventricular single chamber pacing (VVI) with respect to prognosis and antiarrhythmic effect in patients with sick sinus syndrome.

Several studies suggest different effects of atrial (AAI) and ventricular single chamber pacing (VVI) for sick sinus syndrome with respect to the suppression of atrial tachycardias and to the prognosis. With this aspect in mind, we studied 222 patients with sick sinus syndrome, 110 of whom had been supplied with AAI systems, and 112 with VVI systems, in the period from January 1978 to December 1986. The mean observation period was 53 +/- 28 months.

[30 years cardiac pacemaker therapy: a status evaluation].

Antibradycardiac pacemaker therapy has become established as one of the most effective forms of cardiological therapy for the indications AV-block, sick sinus syndrome, bradyarrhythmia, and hypersensitive carotid sinus. About 220,000 systems are implanted per year worldwide, about 32,000 in West Germany. Of the pacing modes, the fixed-rate ventricular single chamber systems (VVI) dominate with a share of almost 90%.

[Acute and chronic effects of UDCG 115 BS (pimobendan) in patients with advanced myocardial failure].

In a double-blind, placebo-controlled cross-over study acute hemodynamic effects of oral UDCG 115 BS (5 and 10 mg) were investigated in myocardial heart failure before (n = 16) and after (n = 13) chronic treatment (4 weeks). Before chronic treatment, UDCG 115 BS induced a similar increase in cardiac index with both doses (5 mg: from 2.4 +/- 0.

[Ultra-high dose thrombolytic therapy with streptokinase in peripheral venous thrombosis].

56 patients with deep vein thrombosis (lower limb) and two patients with vena subclavia thrombosis were treated for six hours/day according to an ultrahigh dosage scheme (1,500,000 U/h streptokinase). An average number of three cycles was applied. Complete recanalization could be demonstrated in 23 patients (43%) with lower limb thrombosis, whereas a partial recanalization was demonstrable in 40% (22 patients).

Physical movement sensitive pacing: comparison of two "activity"-triggered pacing systems.

The Activitrax (A) and the Sensolog (S) pulse generator units were compared during bench tests and in patients both under ergometric conditions and during daily activities to determine the susceptibility of both systems to external noise. During the bench tests both pacemakers were mounted on a swingboard and subjected to controlled vibrational force. The patients were divided into two groups of 10 patients each, one group with A and the other with S units; the discriminating power of workload changes was examined under treadmill exercise.

First clinical experience with an oxygen saturation controlled pacemaker in man.

This article describes the characteristics of a new implantable pacemaker controlled by right atrial oxygen saturation and reports the first clinical experience in man. During the observation period over 5 months, there was no evidence of malfunction due to tissue growth. The system's reaction to exercise changes proved to be quick (5 s to 17 s); decay times varied depending on the magnitude of the power previously performed.

Analysis accuracy and susceptibility to faults of Holter functions in diagnostic pacemakers.

The analysis accuracy and susceptibility to faults of the additional diagnostic functions were tested in 16 patients (eight men, eight woman, average age 61.5 +/- 10.8 years, 14 VVI, 2 AAI) with diagnostic pacemakers (Quintech DPG 921).

The combined use of hysteresis and Holter functions improves diagnosis and therapy in patients with sick sinus syndrome.

We used the Holter functions of an implantable pacemaker in 12 patients with sino-atrial disease suffering from Adam-Stokes attacks to analyze the effects of hysteresis programming. The basic pacing rate of 50 ppm combined with a programmed hysteresis value of 10 to 20 ppm led to a drastic reduction in competition between paced and spontaneous beats: the percentage of paced beats decreased from 20.1% without hysteresis to 1.

A new multisensor pacing system using stroke volume, respiratory rate, mixed venous oxygen saturation, and temperature, right atrial pressure, right ventricular pressure, and dP/dt.

A new multisensor pacing device using respiratory rate (RR), stroke volume (SV), oxygen saturation (SO2), temperature (T), right atrial pressure (RAP), right ventricular pressure (RVP) and right ventricular dP/dt, has been developed. It consists of a 7F multisensor catheter and an external pacing unit. It allows simultaneous recording of the input signals and the corresponding data can be compared among the different parameters under identical conditions.

[Holter functions in cardiac pacemakers: expanding diagnostic possibilities and their clinical relevance].

By encompassing diagnostic multifunctions, microprocessor equipped pulse generators represent a marked improvement in the field of diagnosis and treatment. In this sense, bioelectrical data can be recorded over long periods, up to years, making a continuous follow-up possible. Changes in basic cardiac rhythm, pacemaker malfunctions, effect of parameter programming, even the assessment of antiarrhythmic therapy are some information that could be acquired.

[Accuracy of analysis and susceptibility to faults in ECG detection using pacemakers with diagnostic functions].

The accuracy of analysis and susceptibility to faults of additional diagnostic functions in pacemakers were tested in 16 patients (eight men, eight women, average age 61.5 +/- 10.8 years, 14 VVI, 2 AAI) with diagnostic pacemakers (Quintech DPG 921).

[Body movement as pacemaker induction value: comparison of 2 activity-triggered pacemakers].

This article compares the rate behavior of the activity-triggered pacemakers, the Activitrax (A) and the Sensolog (S), during bench tests as well as in patients under defined ergometric conditions and during every day life with special reference to the susceptibility of both systems to external noise. In the bench tests both pacemakers were mounted on a swingbord and subjected to controlled vibrational force. In the first experiment the frequency, in the second experiment the energy was varied.

[Stroke volume, central venous oxygen saturation and blood temperature as control parameters of frequency-adapted pacemaker stimulation].

In order to compare various physiological parameters under identical conditions and to evaluate the "optimal" combination of parameters for triggering a pacing system, a multisensor-catheter of 7 F size was developed. By this catheter placed in the right ventricular cavity, sinus rate (SR), mixed venous oxygen saturation (SO2), temperature (T) and stroke volume (SV) were continuously recorded in 7 volunteers. SR, T, SO2 and SV were analysed for their steady state relationships to workload (P) and for their dynamic characteristics during standardized exercise tests.

Physiological pacing: present status and future developments.

With the increasing tendency to implant pacemakers not only for life-threatening bradycardias but also for improving cardiodynamics in patients with bradycardia, it soon became apparent that classical VVI pacing is not truly able to optimize circulatory performance. Experience has shown that with ventricular pacing augmentation of cardiac output takes place only initially but is not maintained on a long-term basis, exercise capacity remains markedly reduced, there is only an unsatisfactory influence on the degree and course of heart failure and, in an occasional patient, cardiac function may even deteriorate as compared to the situation prior to pacing. Because the disappointing hemodynamic effect of fixed rate ventricular stimulation was at least partly due to the "unphysiological" mode of pacing provided by those systems which fail to restore AV synchrony and to increase heart rate with changing metabolic requirements, so called physiological pacemakers were developed.

Rate control with an external SO2 closed loop system.

In 20 volunteers (mean age 35.5 y) and 12 pacemaker patients (mean age 68.7 y), central venous oxygen saturation (SO2) was monitored continuously by means of an optical sensor integrated in an external transvenous pacing lead placed in the right ventricular cavity.

Mitral valve closure and left ventricular filling time in patients with VDD pacemakers. Assessment of the onset of left ventricular systole and the end of diastole.

The effect of mitral valve closure on left ventricular filling time and its relation to the onset of systole were assessed from mitral valve echocardiograms and simultaneous apex cardiograms in 21 normal subjects, 11 patients with left bundle branch block, and 19 patients with VDD pacemakers programmed for atrioventricular intervals of 50, 150, and 250 ms. The interval between the electrocardiograph Q wave and the apex cardiogram upstroke was similar in normal subjects and patients with left bundle branch block, but was significantly longer in patients with VDD pacemakers at all atrioventricular intervals. Similarly there was little difference in the time interval between the Q wave and mitral valve closure in normal individuals and patients with left bundle branch block but this was considerably delayed in VDD pacemaker patients with the atrioventricular interval set at 50 ms.

[New statistical criteria for validation of the antiarrhythmic effects by acute oral testing].

There are no reliable criteria for the evaluation of acute effects after oral application of a high single dose of an antiarrhythmic agent from the analysis of data of 46 patients with frequent complex VPBs suffering from severe organic heart disease (19 CHD, 27 COCM), we developed a new statistical model. Our calculations were based on nine 10 h Holter ECGs (2 controls, 1 placebo test, 6 class 1 antiarrhythmic agent tests) and two 24 h Holter ECGs (1 control, 1 while on chronic treatment) recorded in each patient. Usually reductions in VPB frequency caused by the medication occurred within 1 hour after application and lasted greater than or equal to 4 hours.

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.