A Easley

University of Nebraska at Omaha, Omaha, NE, United States

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Publications (15)47.88 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Vasovagal syncope is the most common cause of syncope, but its risk for driving remains uncertain. We analyzed the clinical characteristics of patients who had syncope during driving and subsequently underwent the head-up tilt test (HUTT). Of the 245 consecutive patients undergoing HUTT, 23 (9%) had > or =1 episode of syncope during driving. HUTT was positive in 19 (group A) and negative in 4 (group B) patients. No patient had structural heart disease. In group A, the driving incident occurred on the first syncope in 3 patients, and the other 16 patients had 1 to 4 episodes of prior syncope not associated with driving. In group B, the driving incident occurred on the first syncope in 1 patient, and the other 3 patients had prior syncope (3 episodes in each) not associated with driving. Seven group A and 1 group B patients had 2 syncope-related driving incidents, and the remaining patients had only 1 syncope-related driving incident. The syncope-related driving incidents caused personal injury in 7 group A and 2 group B patients. One incident in 1 group A patient caused the death of another driver. After HUTT, all but 1 patient in group A received medical treatment and only 1 patient in group B received empirical beta-blocker therapy. During the follow-up of 51+/-26 months, 1 patient died and another was lost to follow-up. Of the remaining patients, 4 patients had recurrence of syncope and 2 patients had presyncope in group A. One of these patients had another syncope-related driving incident. No group B patient had syncope recurrence. A second etiology of syncope was never found in any patient. We conclude that vasovagal syncope during driving is not uncommon in patients referred for syncope evaluation. Early medical attention to patients with vasovagal syncope may help reduce syncope-related driving incidents.
    The American Journal of Cardiology 01/2000; 85(2):184-6. · 3.21 Impact Factor
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    ABSTRACT: We repeated direct-current cardioversion of atrial fibrillation after ibutilide injection in patients who failed conventional cardioversion. Eleven of 12 patients (92%) had successful cardioversion and avoided the need for internal cardioversion.
    The American Journal of Cardiology 12/1999; 84(9):1096-8, A10. · 3.21 Impact Factor
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    ABSTRACT: In programming the implantable cardioverter defibrillator (ICD), the ventricular tachycardia (VT) detection cycle length (CL) is based on the CL of the documented tachycardia but the ventricular fibrillation (VF) detection CL is set arbitrarily. Appropriate programming of VF detection may not only reduce the incidence of inappropriate ICD shocks for non-VF rhythms but can also avoid the fatal underdetection of VF. The mean VFCL may provide a useful parameter for optimal ICD programming for VF detection if it is reproducible. This study examined the intrapatient reproducibility and interpatient variation of the mean VFCL in 30 ICD patients (25 men and 5 women, mean age 63 +/- 13 years). A total of 210 VF episodes (7 +/- 4 per patient, range 3-17) induced by T-wave shocks (166) or AC (44) at the ICD implant (30 patients) and the predischarge test (12 of 30 patients) were analyzed. The mean VFCL was calculated from the stored V-V intervals in the ICDs. Although the mean VFCL varied significantly from 171 +/- 6 to 263 +/- 11 ms (P < 0.01) among different patients, it was reproducible among different VF episodes in an individual patient (maximal variation 4-50 ms, P > 0.05). The mean VFCL was not significantly different between patients with and without antiarrhythmic drugs (210 +/- 32 vs 210 +/- 23 ms, P > 0.05) and was correlated with the ventricular effective refractory period (r = 0.5, P < 0.05). The mean VFCL varies greatly among different patients but remains reproducible in an individual patient, suggesting that the mean VFCL may serve as a reference for ICD programming of VF detection.
    Pacing and Clinical Electrophysiology 10/1998; 21(9):1789-94. · 1.75 Impact Factor
  • H Li, A Easley, W Barrington, J Windle
    Pacing and Clinical Electrophysiology 08/1998; 21(7):1470-2. · 1.75 Impact Factor
  • H Li, A Easley, W Barrington, J Windle
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    ABSTRACT: AF is the most common sustained cardiac arrhythmia. Recognition and appropriate management of AF is important to optimize care of concurrent medical problems and prevent long-term consequences. DC cardioversion under sedation should be performed in patients with pulmonary edema, angina, or hypotension. Ventricular rate control is the first choice in stable patients with rapid ventricular rate. Anticoagulation should be considered in all patients with AF duration < 48 hours, except for those under 65 years old and having no other risk factors of stroke. Recent data imply that early attempts at cardioversion may increase success rates and decrease AF recurrence rates. Thus, transesophageal echocardiogram-guided early cardioversion may become more widely used.
    Emergency Medicine Clinics of North America 06/1998; 16(2):389-403. · 0.83 Impact Factor
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    ABSTRACT: Infection and implantable cardioverter-defibrillator shocks are important contributing factors to discontinuation of cardioverter-defibrillator therapy in non-terminally ill patients. These patients are at a high risk of sudden cardiac death despite continued antiarrhythmic drug therapy.
    The American Journal of Cardiology 06/1998; 81(10):1203-5. · 3.21 Impact Factor
  • The American Journal of Cardiology 05/1998; 81(10). · 3.21 Impact Factor
  • H Li, A Easley, J Windle
    Pacing and Clinical Electrophysiology 02/1997; 20(1 Pt 1):122-4. · 1.75 Impact Factor
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    ABSTRACT: Pericardial constriction associated with the placement of intrapericardial defibrillator patches is a rare occurrence that is reported only one tenth as often in defibrillator patients as in patients undergoing other types of cardiac operations. Although this discrepancy may be attributable to a lower incidence of constriction with the defibrillator patch electrode procedure, it may also indicate a failure to recognize that progressive right heart failure and signs of low cardiac output that could be due to pericardial constriction and not progressive systolic dysfunction. Because surgical removal of the patches and decortication of the epicardial surface is the only effective therapy, it is important to recognize this uncommon, but profoundly debilitating entity.
    The Annals of Thoracic Surgery 11/1995; 60(4):1112-5; discussion 1115-6. · 3.45 Impact Factor
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    ABSTRACT: With the increasing flexibility allowed by implantable cardioverter defibrillators that use tiered therapy, it is important to match the therapy with the arrhythmia. In this article we present scatter diagram analysis, a new computationally efficient two-channel algorithm for distinguishing monomorphic ventricular tachycardia (VT) from polymorphic ventricular tachycardia and ventricular fibrillation (VF). Scatter diagram analysis plots the amplitude from one channel versus the amplitude from another channel on a graph with a 15 x 15 grid. The fraction (percentage) of the 225 grid blocks occupied by at least one sample point is then determined. We found that monomorphic VT traces nearly the same path in space and occupies a smaller percentage of the graph than a nonregular rhythm such as polymorphic VT or VF. Scatter diagram analysis was tested on 27 patients undergoing intraoperative implantable cardioverter defibrillator testing. Passages of 4.096 seconds were obtained from rate (bipolar epicardial) and morphology (patch) leads, and digitized at 125 Hz. Scatter diagram analysis distinguished 13 episodes of monomorphic VT (28.6% +/- 4.0%) from 27 episodes of polymorphic VT or VF (48.0% +/- 8.2%) with P < 0.0005. There was overlap in only one monomorphic VT episode and one polymorphic VT or VF episode.
    Pacing and Clinical Electrophysiology 07/1994; 17(7):1267-75. · 1.75 Impact Factor
  • L A Robinson, J R Windle, A R Easley
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    ABSTRACT: The desired defibrillation threshold (DFT) obtained during intraoperative testing of an implantable cardioverter defibrillator (ICD) should be 10 J lower than the maximal energy delivered by the ICD generator. Of the 206 patients undergoing ICD implantation since December 1986, 8 (3.9%) have had initial DFTs with less than the 10-J safety margin using the standard large patch-large patch configuration. Patches were implanted by left thoracotomy in 6 and sternotomy in 1, and 1 had implantation of a transvenous defibrillation lead and subcutaneous patch. Of note, 6 (75%) of the 8 patients with high DFTs had prior open heart operations, half were on a regimen of long-term amiodarone therapy, and the mean left ventricular mass index was quite large but not significantly greater than that of patients with low DFTs. Multiple techniques was tried to improve the DFTs in this group. Satisfactory DFTs were eventually obtained in 7 (88%); the threshold was lowered from a mean of 41.4 +/- 3.8 J to 26.9 +/- 8.8 J (p = 0.002). The most effective techniques were addition of a superior vena cava lead attached by a Y connector to one of the large patch leads in some patients and conversion to a biphasic-waveform generator in 2 others. Adding a third epicardial lead did not lower the DFTs. There were no major postoperative complications or deaths attributable to these supplemental procedures. Using these techniques, satisfactory DFTs were obtained in almost all patients with an ICD.(ABSTRACT TRUNCATED AT 250 WORDS)
    The Annals of Thoracic Surgery 06/1994; 57(5):1184-92. · 3.45 Impact Factor
  • Pacing and Clinical Electrophysiology 02/1993; 16(1 Pt 2):235-41. · 1.75 Impact Factor
  • American Heart Journal - AMER HEART J. 01/1992; 124(3).
  • American Heart Journal 09/1990; 120(2):430-2. · 4.50 Impact Factor
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    ABSTRACT: Signal-averaged electrocardiograms (X, Y and Z leads) were acquired from 24 patients with coronary artery disease and recurrent ventricular tachycardia, 24 control patients with coronary artery disease and 23 normal subjects to assess the discriminant value of fast Fourier transformation of the entire late potential period of the QRS complex. Analysis of the vector magnitude in the temporal domain (25 to 250 Hz bandpass filters) measured high frequency QRS duration, the duration of terminal signals less than 40 microV and the root mean square voltage of the last 40 ms. Late potentials were defined as terminal signals greater than 25 Hz that were less than 40 microV. Analysis in the frequency domain used a 120 ms window that encompassed (had onset with) all of the late potential, but the mean value was first subtracted to eliminate a direct current component. High frequency spectral areas (60 to 120 Hz) and the percent high frequency (100 x [60 to 120 Hz/0 to 120 Hz]) were calculated. Results in both temporal and frequency domains were similar in control patients with coronary artery disease and normal subjects. Patients with ventricular tachycardia had a longer high frequency QRS complex (p less than 0.0001) and longer high frequency terminal signals less than 40 microV (p less than 0.0004), but not significantly lower voltage in the last 40 ms. The most useful temporal domain measurement was high frequency QRS duration (if greater than or equal to 120 ms, odds ratio = 8.2). Patients with ventricular tachycardia had increased high frequency spectral areas (p less than 0.0002) in the late potential, and the percent high frequency was especially increased (p = 0.0000; if percent high frequency greater than 3.1%, odds ratio = 18.4). The odds ratio and the area under the receiver operating characteristic curve were both greater for percent high frequency than for high frequency QRS duration (p less than 0.03). All patients with ventricular tachycardia had a high frequency QRS complex greater than or equal to 107 ms or percent high frequency greater than or equal to 3.1% (sensitivity 100%). For a high frequency QRS complex greater than or equal to 107 ms and percent high frequency greater than or equal to 3.1%, specificity was 96%. Therefore, high frequencies in late potentials, not their duration or reduced voltage, most usefully identify patients with coronary artery disease who are prone to ventricular tachycardia.
    Journal of the American College of Cardiology 01/1990; 14(7):1731-40. · 14.09 Impact Factor

Publication Stats

127 Citations
47.88 Total Impact Points

Institutions

  • 1994–2000
    • University of Nebraska at Omaha
      • Department of Internal Medicine
      Omaha, NE, United States
  • 1993–2000
    • University of Nebraska Medical Center
      • • Department of Internal Medicine
      • • Division of Cardiology
      Omaha, Nebraska, United States