Transcoronary Venous Radiofrequency Catheter Ablation of Ventricular Tachycardia

Coronary Venous Ablation of VT. Ventricular tachycardias in coronary artery disease arise mostly from endocardial sites. However, little is known about the site of origin in other diseases. We present the case of an incessant, adenosine-sensitive ventricular tachycardia arising from the lateral wall of the left ventricle in a patient with mildly reduced left ventricular function. Intracardiac mapping suggested an epicardial origin, and the tachycardia was successfully ablated from a coronary sinus branch. After ablation, left ventricular function returned to normal. Transcoronary venous radiofrequency catheter ablation is a new approach for the treatment of ventricular tachycardia. Its value in the management of other types of ventricular tachycardia has yet to he determined.     

Influence of Body Position on Defibrillation Thresholds of Nonthoracotomy Implantable Defibrillators:

DFT of Nonthoracotomy Defibrillators. Introduction : Defibrillation thresholds (DFTs) usually are determined with the patient in the supine position. However, patients may be in the upright position when a shock is delivered during follow-up, which may explain some first shock failures observed clinically. This study investigated whether body posture affects defibrillation energy requirements of nonthoracotomy implantable cardioverter defibrillators with biphasic shocks.
Methods and Results : Using a step up-down protocol, DFTs were compared intraindividually in 52 patients ("active-can" systems in 41 patients, two-lead systems in II patients) for the supine and upright positions as achieved by a tilt table. The mean DFT was 7.3 ± 4.2 J in the supine versus 9.2 ± 4.8 J in the upright position (P = 0.002). Repeated comparison in reversed order 3 months after implantation in 22 patients revealed thresholds of 6.2 ± 2.5 J (supine) versus 8.4 ± 3.7 J (upright; P < 0.03) 1 week and 4.4 ± 2.4 J (supine) versus 6.2 ± 4.1 J (upright; P < 0.04) 3 months after implantation. DFTs decreased significantly for both body positions from 1 week to 3 months after implantation (P < 0.04).
Conclusion :(I) DFTs for biphasic shocks delivered by nonthoracotomy defibrillators are higher in the upright compared to the supine body position. (2) Differences remain significant 3 months after implantation. For both body positions, DFT decreases significantly from 1 week to 3 months after implantation. These findings have important implications for programming first shock energy to lower than maximal values or for development of devices with lower maximal stored energy.     

Effect of Subcutaneous Infiltration Anesthesia on Pain in Photodynamic Therapy: A Controlled Open Pilot Trial

BACKGROUND: Photodynamic therapy (PDT) has been established as a treatment option for nonmelanoma skin cancer, such as superficial basal cell carcinoma, actinic keratoses, or Bowen's disease. OBJECTIVE: A major drawback of PDT is pain during treatment that can cause extreme distress for some patients. METHODS: This study was a controlled, open trial comparing PDT in 16 patients on one side of the face with orally administered analgesics and PDT on the contralateral side of the face with subcutaneous infiltration anesthesia (SIA). The 5-aminolevulinic acid gel was applied 5 hours before treatment. Pain was assessed by the patient using a visual analog scale directly after treatment. RESULTS: Fifteen of 16 (94%) patients reported less pain during PDT after SIA compared to oral analgesics only. This effect was significant (Wilcoxon test for matched pairs, p= .001). No side effects due to SIA were observed. CONCLUSION: SIA is an effective and rather safe method for the control of PDT-associated pain.     

Dental fear in children and adolescents: a comparison of forms of anxiety management practised by general and paediatric dentists

International Journal of Paediatric Dentistry 2011; 22: 60–67 Background. About 11% of children and adolescents suffer from dental fear. These young people run an increasing risk of undergoing more invasive treatments. Aim. We researched the management of dental anxiety in young patients by general and paediatric dentists as well as by trained and untrained dentists. Design. Eight hundred dentists in Germany were interviewed via e‐mail regarding their experience, treatment techniques, information material and complications during the treatment of fearful children. We also examined how difficult dentists judge the treatment of anxious children and how often they participate in continuing education courses. Results. Paediatric dentists applied a greater spectrum of management techniques than general dentists. They used more often psychotherapeutic interventions and anxiety assessment questionnaires. Dentists who frequently attend in continuing education courses judged the treatment to be less difficult and also used psychotherapeutic interventions more often. Conclusions. German paediatric dentists and dentists who take continuing education courses utilise a broader range of techniques to manage dental anxiety. They may be eminently suited to treat children with severe forms of anxiety. Therefore, dentists who treat young patients should participate in education programmes so as to reduce both the anxiety of their patients and their own anxiety.     

Metalloporphyrins,used for HO‐1 Inhibition,Themselves Affect Hepatic Microcirculation,Liver Function,and Hepatocellular Integrity

Background: Metalloporphyrins (MPs) are broadly used in the studies of the role of the heme oxygenase (HO)‐1 system in different stress models. However, possible side effects of the MP administration itself have to be further investigated. Methods: Sin IV mesoporpyhrin IX (SnMP; 10 μmol/kg body weight), tin protoporpyhrin IX (SnPP; 50 μmol/kg body weight), or chromium mesoporpyhrin IX (CrMP; 40 μmol/kg body weight) were administered to Sprague‐Dawley rats (each group, n=5). The hepatic microcirculation was assessed by intravital microscopy (IVM). Blood samples were taken and the activity of HO‐1 inhibition was measured by the determination of bilirubin accumulation after bile duct ligation. Results: CrMP administration led to a decrease in mean arterial pressure. CrMP induced a marked hemolysis, a significant decrease of sinusoidal diameter and blood flow, and a marked inflammatory response. SnMP decreased sinusoidal diameters; however, this was compensated by an increase of sinusoidal red blood cell velocity. SnPP, but not SnMP, led to an increase of the number of nonperfused sinusoids. SnPP and CrMP revealed a two‐fold increase in aspartite aminotransferase values after the completion of the IVM. The administration of MPs led to a 40%–50% decrease in the levels of conjugated bilirubin therapy, indicating that they actually inhibit HO‐1 activity. Conclusions: The administration of MPs affects both the systemic macrohemodynamics and the hepatic microcirculation. As SnMP displayed the smallest number of side effects, this MP can be recommended for the studies of the HO‐1 action on the liver microcirculation.     

Analysis of the P Wave in the Signal-Averaged Electrocardiogram: Normal Values and Reproducibility

To apply p wave analysis of the signal-averaged electrocardiogram (SAECG) clinically, the knowledge of normal values and the verification of highly reproducible measurements are essential. In 40 healthy volunteers (ages 23 -37 years), an SAECG of the p wave was performed and then repeated after 1 week and 1 month. In addition to Simson analysis (unidirectional and bidirectional filters), the data were filtered with finite impulse response (FIR) and least squares fit (LSQ) filters to obtain a better differentiation between the end of the p wave and QRS onset. All recordings were evaluated by two independent observers, and the following parameters were calculated: the duration of the p wave in the three unfiltered leads; and for the vector magnitude of the three leads x, y, and z: the duration of the p wave and the root mean square voltage of its last 30, 20, and 10 ms. The average p wave duration was significantly different among the various filter techniques: 135 ± 7 ms (unidirectional); 97 ± 8 ms (bidirectional); 109 ± 8.5 ms (FIR); and 126 ± 10 ms (LSQ) (P = 0.001 for each comparison). There was a good reproducibility of the data analyzed with the Simson method (R = 0.80–0.91). Filtering with the FIR and LSQ leads to a considerably greater variability.     

Clinical Experience with the Rate Responsive Pacemaker Sensolog® 703

Pacemaker therapy with rate responsive systems becomes increasingly more important. Numerous clinical and experimental trials have been conducted thus far to investigate different sensors of metabolic demands of the body, functioning independently of an atrial electrogram. To transform mechanical energy into electrical energy, activity-triggered systems utilize a piezo-quartz as their sensor. Thirty jive patients suffering from pathological bradyarrhythmias and therefore from an inadequate increase of the heart rate during exercise were supplied with a Sensolog® 703. Clinical follow-up was first performed with the help of treadmill ergometry, later on by walking on flat ground and climbing steps. The settings due to the first test caused inadequately high stimulation rates. A 24-h-Hoher-ECG was necessary to control the programming and the rate profile in the patient's daily life. Using only the histogram and the rateread function, all rate adaptive parameters of the Sensolog® 703 could be set by walking on flat ground and climbing steps. We defined a frequency of 75–85 min⁻¹ to be appropriate during walking, respectively "low work." Individual programming ranged from 2–5/8–15/high-low/very fast-medium/fast-medium (slope, threshold, gain, reaction and recovery time). Reprogramming based on 24-h-Holter ECG was only necessary if the pacemaker was formerly adjusted with the help of treadmill ergometry. Besides, we observed an increase of the stimulation rate due to vibrations not related to exercise, e.g., by driving in a car.     

TO HAVE AND HAVE NOT: ADAPTIVE BEREAVEMENT BY TRANSFORMING MENTAL TIES TO THE DECEASED

Over the past decade, there has been a paradigm shift in the field of bereavement: From the traditional view that insists on the necessity of disengagement, toward a position that postulates the need for a continuing connection. The authors propose to move beyond the dichotomy that was created by the two paradigms and conceive of it as a process of transformation that involves both disengagement and connection. Drawing on theoretical frameworks of control and adaptation, the authors suggest that the relationship with the deceased may be transformed to mental representations of this person that carry substitute value.