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Pleomorphic Ventricular Tachycardia: Demonstration of Conduction Reversal Within the Reentry Circuit
KARL-HEINZ KUCK MICHAEL SCHLÜTER KLAUS-PETER KUNZE MANFRED GEIGER 《Pacing and clinical electrophysiology : PACE》1989,12(7):1055-1064
A case is presented of a patient with incessant venfricular tacbycardia of left bundle branch block morphology. Endocardial mapping revealed the site of earliest activation during tachycardia to be the proximal right ventricular septum. Pacing at this site elicited the clinical tachycardia, whereas pacing at the proximal left ventricular septum induced a right bundle branch block morphology identical to that of a previously recorded spontaneous ventricuiar tachycardia. Electrophysiological evidence is given that both types of tachycardia originate from a single reentry circuit located in the proximal ventricular septum in which the reentrant wavefront may travel either orthodromically (during spontaneous tachycardia and right ventricular pacing) or antidromically (during left ventricular pacing). 相似文献
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KLAUS-PETER DIECKMANN JOHANNES CLASSEN VOLKER LOY 《APMIS : acta pathologica, microbiologica, et immunologica Scandinavica》2003,111(1):64-69
Germ cell tumours (CT) are no true carcinomas; therefore the term testicular intraepithelial neoplasia (IN) is probably more appropriate than “CIS”. The diagnostic accuracy of a single‐site biopsy is an open question. We experienced 9 false‐negative biopsies among 1859 cases. Thus, the proportion of a failed diagnosis is 0.5%. The main reason for diagnostic failure is the non‐random distribution of TIN within the testicle. Currently we are investigating whether a two‐site biopsy is more accurate than a single biopsy. In the ongoing trial, the over‐all prevalence of TIN is around 5.3%, so far. In one quarter of the positive cases the lesion was found in only one of the two specimens. Thus, a double biopsy appears to be more favourable than the traditional single biopsy. Surgical complications amount to 2.5% in that double biopsy study. Only one surgical re‐intervention was required among 983 patients. Serial imaging studies with scrotal sonography and magnetic resonance imaging (MRI) disclosed a transient intratesticular haematoma/oedema postoperatively. So, testicular biopsy, even when performed at two sites is in fact a low‐complication procedure. Low dose radiotherapy to the testis is the treatment of choice for TIN. However, more than one quarter of patients require testosterone supplementation secondary to androgen‐deficiency. Two dose‐reduction studies (Denmark and Germany) had to be terminated prematurely because unexpected relapse of TIN was encountered at 14 Gy and 16 Gy. Possibly, hyperfragmentation schedules can overcome the antagonism of androgenic compromise and oncological safety. In a nation‐wide survey, it was shown that contralateral biopsies were routinely performed in 66% of the urological departments in Germany. Another 19% offered the biopsy to particular “risk‐cases”; only 15% never did a biopsy. Among those refusing biopsies, there was a higher proportion of small hospitals and a significantly lower annual case‐number of GCT, when compared to those doing the biopsy. Thus, the contralateral biopsy is a well‐established procedure among German urologists; those with a high caseload of GCT particularly appreciate it. 相似文献
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KARL-HEINZ KUCK WARREN M. JACKMAN JAN PITHA KLAUS-PETER KUNZK LEE CARMEN SÖREN SCHRÖDER CHRISTOPH A. NIENABER 《Pacing and clinical electrophysiology : PACE》1988,11(6):760-775
For potential application in ablating left free-wall accessory AV pathways with direct current shocks, a new epicardial-endocardial electrode configuration, designed to focus the current field across the mitral annulus, was tested in dogs. A catheter electrode in (he coronary sinus (epicardial electrode) was used as the cathode, and a catheter electrode in the left ventricle (endocardial electrode) placed beneath the mitral valve, high against the mitral annulus and directly across from the epicardial electrode formed the anode. Two shocks, each of 30, 40, or 50 joules (J) were delivered in nine, three, and four dogs, respectively. The first shock was applied to the anterior or lateral wail and the second shock to the posterior wall, except in one dog which received one anterior and one lateral shock. Two dogs receiving 50] shocks died acutely, one due to rupture of the coronary sinus and cardiac tamponade and the other had unexplained electromechanical dissociation. The remaining 14 dogs tolerated the two shocks well and were sacrificed 3–5 days later for pathological examination of the heart. Shocks in the anterior and lateral regions produced atrial necrosis (height 1.5–11 mm, width 1.5–12 mm and depth 1–3 mm) in 10 of 14 dogs and ventricular necrosis (height 4–27 mm, width 4–33 mm, and depth 5–14 mm) in all 14 dogs. Ideal lesions with atrial necrosis extending down to the annulus and ventricular necrosis extending to the epicardial aspect of the ventricular crest occurred in five dogs in which the endocardial electrode was positioned high against the annulus. In the other nine dogs, the endocardial electrode was located 6–18 mm below the annulus, as estimated by the center of ventricular necrosis. In these dogs, the ventricular lesions did not extend to the epicardial aspect of the crest and, in four dogs, no atrial necrosis was found. Shocks delivered to the posterior wall produced no atrial or ventricular necrosis except in one dog receiving a 50 J shock. It is concluded that, using the epicardial-endocardial electrode configuration with the LV catheter positioned high against the annulus, shocks of less than 50 J in dogs safely produce atrial and ventricular necrosis adjacent to the mitral annulus in the anterior and lateral regions but not in the posterior regions. Similar lesions in man may be capable of interrupting left anterior and lateral accessory AV pathways. 相似文献
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CHRISTOPH STELLBRINK KLAUS-PETER KUNZE PETER HANRATH 《Pacing and clinical electrophysiology : PACE》1995,18(9):1717-1720
STELLBRINK, C., et al .: Preexcitation in Hypertrophic Cardiomyopathy: A Case of a Fasciculoventricular Mahaim Fiber . A patient with hypertrophic cardiomyopathy (HCM) who presented with preexcitation pattern on the surface ECG suggestive of the Wolff-Parkinson-White (WPW) syndrome is described. Intracardiac electrophysiological study revealed a fixed anomalous QRS complex and a short fixed His-ventricular interval indicating a fasciculoventricular Mahaim fiber. As this specific form of accessory connection does not cause reentrant tachycardias, no treatment was required. It is important to distinguish this entity from atriofascicular or nodoventricular Mahaim fibers or the WPW syndrome in patients with HCM showing a preexcitation pattern in the surface ECG, as these may cause life-threatening arrhythmias in this patient population. 相似文献
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KLAUS-PETER. KUNZE M.D. MICHAEL. SCHLUTER PH.D. MANFRED. GEIGER M.D. KARL-HEINZ. KUCK M.D. 《Journal of interventional cardiology》1988,1(4):277-284
A new technique is presented in which atrioventricular (A V) nodal conduction properties can be altered in a controlled way through the application of radiofrequency current. In 13 patients with supraventricular arrhythmias (maximal heart rate 215/min) radiofrequency current was delivered to the A V node via a catheter. Nine patients had atrial fibrillation, three had A V nodal reentrant tachycardia, and one patient had accessory pathway mediated A V tachycardia. Radiofrequency current application in these patients increased AV nodal conduction time and antegrade A V nodal effective refractory period significantly. In three patients radiofrequency current had no effect, and the A V node was ablated with direct current shocks. During a mean follow-up period of 10 ± 3 months, all ten patients in whom radiofrequency current application had been successful were asymptomatic without antiarrhythmic medication. No complications were observed, neither during nor after the procedure. 相似文献
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STEPHAN BALDUS M.D. JACOBUS REIMERS M.D. RALF KÖSTER M.D. JAN KÄHLER M.D. KLAUS-PETER SCHAPS M.D. JOHANN BOLTE M.D. † CHRISTIAN W. HAMM M.D. 《Journal of interventional cardiology》2000,13(3):167-172
We report a 64-year-old patient with single vessel coronary disease who initially underwent PTCA and stent implantation for a complex RCA lesion. The patient was subsequently readmitted for unstable angina pectoris after 2 and 6 months. Coronary angiograms each time revealed subtotal reocclusions of the target vessel due to in-stent restenosis. At 2 months, the patient underwent rotational atherectomy and additional stent implantation, During the second reintervention at 6 months rotational atherectomy was followed by implantation of two membrane-covered stent deployed within the conventional stents (stent-indent). Subsequently, the patient remained asymptomatic. Control angiography after 5 months revealed only minor stent lumen loss not requiring reintervention. Membrane-covered stents appear to be a promising alternative to reduce the incidence and degree of in-stent restenosis in selected lesions. 相似文献
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KARL-HEINZ KUCK KLAUS-PETER KUNZE MICHAEL SCHLÜTER MANFRED GEICER WARREN M. JACKMAN 《Pacing and clinical electrophysiology : PACE》1989,12(10):1681-1690
A case is presented of a 20-year-old woman with a history of three episodes of syncope within the last 4 years, which was caused by a rapid ventricular response to atrial fibrillation via a left-sided posterior accessory pathway. A variety of antiarrhythmic agents had failed to control the arrhythmia. Using a novel dual catheter approach, with one catheter in the coronary sinus and an adjacent catheter in the left ventricle close to the mitral annulus, accessory pathway conduction was successfully interrupted by two radio-frequency current applications between the tip electrodes of the two catheters. During follow-up, 12-lead electrocardiograms have been normal and the patient has been asymptomatic. 相似文献
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