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排序方式: 共有96条查询结果,搜索用时 15 毫秒
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ANDREAS MARKEWITZ HANS KAULBACH SÖREN MATTKE UWE DORWARTH ELLEN HOFFMANN CHRISTIAN WEINHOLD GERHARD STEINBECK BRUNO REICHART 《Pacing and clinical electrophysiology : PACE》1995,18(3):401-405
The optimal placement for the second defibrillation lead in a twolead system has never been addressed. We retrospectively reviewed the data of 33 patients with an average age of 59.2 years (range 41–78 years), predominantly mala (n = 29), who underwent implantation of a cardioverter defibrillator (ICD) for treatment of ventricular tachycardia (n = 19) or ventricular fibrillation (n = 14). In all patients an attempt was made to implant an endovenous ICD device (leads only, no subcutaneous patch). In group I (n = 18) the defibrillation anode, a separate unipolar lead, was placed in the common position, the superior vena cava. In group II (n =15) the lead was placed in the left subclavian vein. At least two consecutive shocks reverting ventricular fibrillation at energies ±24J were required for implantation of the ICD device. All shocks were monophasic. The success rate of endovenous defibrillation was significantly higher in group II than in group I (67% vs 28%, P < 0.05). Thus, it could be demonstrated that the position of the defibrillation anode can influence the defibrillation efficacy in transvenous ICD systems. Prospective randomized trials are needed to investigate the optimal position for the second defibrillation electrode, which may gain increasing importance as soon as dual chamber ICDs become available. 相似文献
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SÖREN MATTKE MICHAEL FIEK REAS MARKEWITZ DIETER MÜLLER ELLEN HOFFMANN MICHAEL SCHMÖCKEL GERHARD STEINBECK 《Pacing and clinical electrophysiology : PACE》1996,19(12):2083-2088
The unipolar system for transvenous defibrillation, consisting of a single right ventricular lead as the cathode and the device shell as anode, has been shown to combine low de- fibrillation thresholds (DFTs) and simple implantation techniques. We compared the defibrillation efficacy of this system with the defibrillation efficacy of a dual lead system with a 12-cm long defibrillation anode placed in the left subclavian vein. The data of 38 consecutive patients were retrospectively analyzed. The implantation of an active can system was attempted in 20 patients (group 1), and of the dual lead system in 18 patients (group 2). Both groups had comparable demographic data, cardiac disease, ventricular function, or clinical arrhythmia. The criterion for successful implantation was a DFT of > 24 J. This criterion was met in all 18 patients of group 2, The active can system could not be inserted in 3 of the 20 group 1 patients because of a DFT > 24 J. In these patients, the implantation of one (n = 2) or two (n = 1) additional transvenous leads was necessary to achieve a DFT ≤ 24). The DFTs of the 17 successfully implanted group 1 patients were not significantly different from the 18 patients in group 2 (12.3 ± 5.7 f vs 10.8 ± 4.8 J). The defibrillation impedance was similar in both groups (50.1 ± 6.1 ± 48.9 ± 5.2 Ω). In group 1, both operation duration (66.8 ± 17 min vs 80.8 ± 11 min; P < 0.05) and fluoroscopy time (3.3 ± 2.1 min vs 5.7 ± 2.9 min; P < 0,05) were significantly shorter. Thus, the active can system allows reliable transvenous defibrillation and a marked reduction of operation duration and fluoroscopy time. The dual lead system, with an increased surface area defibrillation anode, seems to he a promising alternative for active can failures. 相似文献
5.
URS NIEDERHÅUSER LUDWIG K. VON SEGESSER THIERRY P. CARREL REAS LASKE ERWIN BAUER MARIETTE SCHÖNBEGK MARKO TURINA 《Pacing and clinical electrophysiology : PACE》1993,16(2):303-308
The long-term results after open intracardiac removal of infected pacing electrodes are presented. Methods: between 1985 and 1990 open intracardiac removal of 19 infected pacing electrodes was performed in seven patients (six male and one femalel, with a mean age of 56 years. The indications were; persisting bacteremia in three; generator pocket infection in four; endocarditis in one; and ventricular tachycardia caused by retracted electrodes in one. All electrodes were fixed in the right heart and extraction by closed methods failed. Percutaneous catheter techniques were not applied in these seven patients. In five patients two ventricular electrodes had to be removed, and in two patients a single one. A total of seven atrial electrodes were removed in six patients (one electrode each in five patients; two electrodes in one patient). All atrial and two ventricular electrodes could be removed through a pursestring suture without use of a pump oxygenator. For the removal of ten ventricular electrodes in six patients (two electrodes each in four patients; 1 electrode each in two patients) a right-sided atriotomy was necessary with cardiopulmonary bypass (CPB). Simultaneously, five new pacing systems were implanted. Results; there were no early or late mortalities. In January 1991, all seven patients are alive and in a mean New York Heart Association Class 1,3 of heart failure after a mean interval of 33 months. In all cases the infection could be controlled with a simultaneous antimicrobial chemotherapy and the postoperative period was free of major complications. Conclusion; open intracardiac removal of retained pacing electrodes with or without use of CPB is a safe procedure without major complications. It is mandatory for all infected pacing electrodes that cannot be extracted by closed methods. 相似文献
6.
A Comparison of Quality-of-Life in Patients with Dual Chamber Pacemakers and Individually Programmed Atrioventricular Delays 总被引:1,自引:0,他引:1
JÜRGEN FRIELINGSDORF THOMAS DESEÖ REAS E. GERBER OSMUND BERTEL 《Pacing and clinical electrophysiology : PACE》1996,19(8):1147-1154
Dual chamber pacemakers are increasingly implanted to achieve optimal hemodynamics by AV synchrony, but the effect of AV delay programming on the patient's quality-of-life has been less well studied. The influence of an individually programmed AV delay between 100 and 250 ms on quality-of-life was investigated in a randomized, double-blind crossover study of 13 patients (69 ± 10 years of age) with dual chamber pacemakers implanted because of high degree AV block. During radionuclide ventriculography at rest, the "optimal AV delay" with the maximal left ventricular ejection fraction and the "most unfavorable AV delay" with the least ejection fraction were determined. The ejection fraction at rest with the "optimal AV delay" was 51%± 10%, and with the "most unfavorable AV delay," 44%± 11% (P < 0.0001). The optimal AV delay determined by radionuclide ventriculography correlated well with the optimal AV delay determined by Doppler echocardiography using flow velocity integrals (r = 0.78, P < 0.0016). Each patient was assigned in random order to either AV delay during a 2-week period and then the pacing mode was switched for another 2-week period. At the end of each period, patients were assessed by a functional status questionnaire to assess physical capability and two further questionnaires to quantify cardiovascular symptoms or self-perceived health. There were no differences in the two AV delays regarding the patient's perceived physical capability and specific symptoms. The patient's total judgment was identical to the optimal AV delay (score 36%± 19%) and the most unfavorable AV delay (33%± 21%). Thus, in patients with a dual chamber pacemaker, an individually programmed AV delay affects left ventricular function at rest, but has no influence on quality-of-life. The determination of the flow velocity integral by Doppler echocardiography is a simple and reliable method to optimize the AV delay if necessary. 相似文献
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MAJID HAGHJOO M.D. GERHARD HINDRICKS M.D. Ph.D. KERSTIN BODE M.D. CHRISTOPHER PIORKOWSKI M.D. REAS BOLLMANN M.D. ARASH ARYA M.D. 《Journal of cardiovascular electrophysiology》2009,20(8):935-939
Background: A remote magnetic navigation system (MNS) has been used with a nonirrigated magnetic catheter for ablation of some supraventricular and ventricular arrhythmias. However, the irrigated tip catheter has not been evaluated.
Objective: To evaluate the feasibility and efficiency of the newly available irrigated tip magnetic catheter for radiofrequency ablation (RF) of electrical storm due to scar-related ventricular tachycardia (VT) in patients with ischemic heart disease.
Methods: Between January and March 2008, a total of 4 consecutive patients (4 men, mean age 67.7 years) with electrical storm who had an implantable cardioverter defibrillator underwent radiofrequency ablation using a remote MNS and the new magnetic irrigated catheter.
Results: Five ablation procedures were performed in study patients. Acute success, defined as noninducibility of any monomorphic VT, was obtained in 3 patients. In 1 patient, a nonclinical VT remained inducible. A monomorphic VT corresponding to clinical VT with the median (range) cycle length of 485 (440–580) ms was induced in all patients. The duration of ablation was 2,273 (985–3087) seconds, with median total procedure and fluoroscopy times of 135 (100–150) minutes and 6.5 (5–9) minutes, respectively. One recurrence occurred 1 week after ablation, which was ablated successfully in the second session. No complication was observed after ablation. During mean follow-up of 4.2 months, all patients were in sinus rhythm, they received no ICD therapy, and no mortality occurred.
Conclusions: Irrigated ablation of scar-related ventricular tachycardia guided by remote MNS is a feasible and effective modality for management of the electrical storm in patients with ischemic cardiomyopathy with minimal radiation exposure. 相似文献
Objective: To evaluate the feasibility and efficiency of the newly available irrigated tip magnetic catheter for radiofrequency ablation (RF) of electrical storm due to scar-related ventricular tachycardia (VT) in patients with ischemic heart disease.
Methods: Between January and March 2008, a total of 4 consecutive patients (4 men, mean age 67.7 years) with electrical storm who had an implantable cardioverter defibrillator underwent radiofrequency ablation using a remote MNS and the new magnetic irrigated catheter.
Results: Five ablation procedures were performed in study patients. Acute success, defined as noninducibility of any monomorphic VT, was obtained in 3 patients. In 1 patient, a nonclinical VT remained inducible. A monomorphic VT corresponding to clinical VT with the median (range) cycle length of 485 (440–580) ms was induced in all patients. The duration of ablation was 2,273 (985–3087) seconds, with median total procedure and fluoroscopy times of 135 (100–150) minutes and 6.5 (5–9) minutes, respectively. One recurrence occurred 1 week after ablation, which was ablated successfully in the second session. No complication was observed after ablation. During mean follow-up of 4.2 months, all patients were in sinus rhythm, they received no ICD therapy, and no mortality occurred.
Conclusions: Irrigated ablation of scar-related ventricular tachycardia guided by remote MNS is a feasible and effective modality for management of the electrical storm in patients with ischemic cardiomyopathy with minimal radiation exposure. 相似文献
9.
MICHAEL NIEHAUS REAS SCHUCHERT STEFAN THAMASETT DIETRICH PFEIFFER THOMAS KORTE MAX PICHLMAIER BERNHARD PANNING ROBERTO BELKE JÜRGEN TEBBENJOHANNS 《Pacing and clinical electrophysiology : PACE》2001,24(10):1489-1493
Monitoring of atrial signals improves the accuracy in identifying supraventricular tachyarrhythmias to prevent inappropriate therapies in patients with implantable ICDs. Since difficulties due to the additional atrial lead were found in dual chamber ICD systems with two leads, the authors designed a single pass VDD lead for use with dual chamber ICDs. After a successful animal study, the prototype VDD lead (single coil defibrillation lead with two additional fractally coated rings for bipolar sensing in the atrium) was temporarily used in 30 patients during a German multicenter study. Atrial and ventricular signals were recorded during sinus rhythm (SR), atrial flutter, AF, and VT or VF. The implantation of the lead was successful in 27 of 30 patients. Mean atrial pacing threshold was 2.5 +/- 0.9 V/0.5 ms, mean atrial impedance was 213 +/- 31 ohms. Atrial amplitudes were greater during SR (2.7 +/- 1.6 mV) than during atrial flutter (1.46 +/- 0.3 mV, P < 0.05) or AF (0.93 +/- 0.37 mV, P < 0.01). During VF atrial "sinus" signals had significantly (P < 0.01) lower amplitudes (1.4 +/- 0.52 mV) than during SR. The mean ventricular sensing was 13.3 +/- 7.9 mV and mean ventricular impedance was 577 +/- 64 ohms. Defibrillation was successful with a 20-J shock in all patients. In addition, 99.6% of P waves could be detected in SR and 84.4% of flutter waves during atrial flutter. During AF, 56.6% of atrial signals could be detected without modification of the signal amplifier. In conclusion, a new designed VDD dual chamber lead provides stable detection of atrial and ventricular signals during SR and atrial flutter. Reliable detection of atrial signals is possible without modification of the ICD amplifier. 相似文献
10.
Determinants of Dual Chamber Pulse Generators Longevity 总被引:3,自引:0,他引:3
ANDREAS MARKEWITZ DIETER KRONSKI AGNETA KAMMEYER HANS KAULBACH CHRISTIAN WEINHOLD WITTICH DOERING BRUNO REIGHART 《Pacing and clinical electrophysiology : PACE》1995,18(12):2116-2120
The aim of tbis study was to investigate the effect of battery capacity, internal current drain, and stimulation energy on pulse generators longevity, and if battery impedance measurements can reliably predict pulse generators end-of-life. For this purpose, the records of 577 patients with a mean age of 65 ± 14 years who had undergone implantation of two different dual chamber pulse generators (PGl: 409; PG2:168) were retro-spectively reviewed. Battery capacity were 2.3 Ah (PGl) and 3.0 Ah (PG2) while current drain at compara-ble nominal settings was 20 μA (PGl) and 30 μA (PG2) indicating a higher internal current drain of PG2. After a mean follow-up of 46 ± 23 months, stimulation energy at reprogrammed output settings was significantly higher in PGl as compared to PG2 (17.1 ± 0.14 J vs 15.5 ± 0.24 f). Three PGl (0.7%) and 12 PG2 (7.1%) (P < 0.01) had to be exchanged after a mean of 77.3 ± 5.3 months (PGl) and 75 ± 13.5 months (PG2) (P = NS) due to end-of-life being reached. The difference in battery impedances of PGl and PG2 gained statistical significance 5 years after implantation (1.0 kΩ vs 2.4 ± 6.7 kΩ) preceding the significant difference in PG survival after 6 years (98.7 ± 1.3% vs 90.7 ± 4.8%). These results indicate that internal current drain is the most important determinant of the pulse generators longevity and that battery impedance can reliably predict end-of-life. Therefore, the essential information about internal current drain should be available for each pacemaker, since it is required for adequate pulse generator selection. Diagnostic functions of dual chamber pulse generators should include measurement of battery impedance. 相似文献