C Gottfridsson

Publications of C Gottfridsson

• Spectral turbulence and late potentials in the signal-averaged electrocardiograms of patients with monomorphic ventricular tachycardia versus resuscitated ventricular fibrillation.

  Authors: C Gottfridsson, B Sandstedt, T Karlsson, N Edvardsson

  Scandinavian cardiovascular journal : SCJ. 06/2000; 34(3):261-71.

  Signal-averaged electrocardiograms (SAECG) were analyzed for late potentials and spectral turbulence in 208 patients with ischemic heart disease with a history of sustained monomorphic ventricularSignal-averaged electrocardiograms (SAECG) were analyzed for late potentials and spectral turbulence in 208 patients with ischemic heart disease with a history of sustained monomorphic ventricular tachycardia (MVT) (n = 62), resuscitation from ventricular fibrillation (VF) (n = 64) or no ventricular tachyarrhythmia (n = 82). Receiver operating characteristic curves were utilized to optimize cut-off values for prediction of MVT and VF. Patients with MVT had a lower ejection fraction (mean = 0.37) than patients with VF (0.44; p = 0.01) and controls (0.48; p < 0.0001). The mean FQRSD in MVT patients (126 ms) was longer than in VF and controls (113 ms; p = 0.005 and 102 ms; p < 0.0001, respectively). The RMS40 was lower in MVT (19 microV) than in VF and controls (29 microV; p = 0.0003 and 28 microV; p < 0.0001, respectively); 81% of the MVT patients were spectral turbulence-positive vs 47% of VF patients and 31% of control patients (p < 0.0001 for both differences). With optimized reference values, FQRSD, TQRSD and ISCSD contributed significantly to the identification of MVT patients and FQRSD to VF patients. The sensitivity of combined time-domain and spectral turbulence analysis was 90% for MVT and 58% for VF, with 63% specificity. MVT patients had a lower ejection fraction and were more often late potential and spectral turbulence positive than VF and control patients. These findings indicate that a large electroanatomic substrate is required in MVT. A long FQRSD was a risk marker for both MVT and VF. Spectral turbulence analysis added independent information, and the combination of time-domain and spectral turbulence analysis was superior to either method alone in identifying the MVT patients. Neither method of analysis, singly nor in combination, performed satisfactorily in identification of VF risk.

• The short-term and long-term reproducibility of spectral turbulence and late potential variables of the signal-averaged ECG in a population sample of healthy subjects and the impact of gender, age, and noise.

  Authors: C Gottfridsson, T Karlsson, N Edvardsson

  Journal of electrocardiology. 05/2000; 33(2):107-17.

  Previous methods for frequency domain analysis of the signal-averaged ECG (SAECG) have had low reproducibility. The reproducibility of time domain late potential analysis and spectral turbulencePrevious methods for frequency domain analysis of the signal-averaged ECG (SAECG) have had low reproducibility. The reproducibility of time domain late potential analysis and spectral turbulence analysis was evaluated with 2 immediately consecutive SAECG recordings in 121 randomly selected subjects without heart disease (short-term) and also in 47 subjects after 1 month (long-term). A test was late potential positive if 2 or more of 3 variables were outside the reference limits and spectral turbulence positive if the score was 3 or 4. The short-term reproducibility was high for the filtered QRS duration (FQRSD), root mean square amplitude of the last 40 ms (RMS40) and high frequency low amplitude signals less than 40 microV (HFLAS40) of the time domain and total QRS duration (TQRSD), power spectral density of the last 40 ms and the late potential duration of time domain analogous analyses. The Spearman rank order correlation coefficients were 0.89, 0.88, and 0.84 and 0.97, 0.91 and 0.97, respectively. The reproducibility of the spectral score variables varied, and the correlation for the low slice correlation ratio was 0.71, spectral entropy 0.61, interslice correlation mean 0.58, and interslice correlation SD 0.28. A diagnostic inconsistency between 2 tests occurred in 0 (0%) subjects in late potential analysis if FQRSD was required for positivity, and in 7 (6%) otherwise, and in 9 (7%) of spectral turbulence analysis. If the spectral variable mean peaks per slice, with a correlation of 0.89, replaced interslice correlation SD in the spectral score, diagnostic inconsistency occurred in 0 (0%) subjects. The reproducibility seemed higher in women and in younger people but significantly only for interslice correlation subjects mean and HFLAS40. The long-term reproducibility did not differ significantly from short-term for any variable. In conclusion, the reproducibility was high in all time domain and time domain analogous variables. It varied among the spectral turbulence score variables and was very low for interslice correlation SD. The reproducibility of the spectral score improved substantially if this variable was replaced by mean peaks per slice.

• Full ventricular capture indicated by the QT interval function.

  Authors: C Gottfridsson, I Wallentin, L Dernevik, H Van Rooijen, C Van Groeningen, N Edvardsson

  Pacing and clinical electrophysiology : PACE. 12/1998; 21(11 Pt 2):2171-7.

  The atrioventricular (AV) interval is critical in dual chamber (DDD) pacing in patients with hypertrophic obstructive cardiomyopathy (HOCM) to obtain full ventricular capture (FVC) with maximalThe atrioventricular (AV) interval is critical in dual chamber (DDD) pacing in patients with hypertrophic obstructive cardiomyopathy (HOCM) to obtain full ventricular capture (FVC) with maximal reduction of the left ventricular (LV) outflow gradient and optimal LV diastolic filling. We studied the relationship of FVC, fusion, spontaneous AV conduction, and the QT interval. METHODS: 11 patients with various cardiac diseases and stable AV conduction received a QT sensing Diamond, Vitatron, DDD pacemaker. Software was downloaded into the pacemaker. In the DDD pacing mode, with the QT interval measured from the ventricular pacing stimulus to the end of the T wave, the AV interval was shortened from 400 ms, in 20-ms steps, to 90 ms. At 90 ms the stimulation rate was increased by 30 beats/min and the AV interval was increased stepwise. FVC and fusion was examined on the surface ECG. RESULTS: At 400 ms interval, spontaneous AV conduction inhibited the pacemaker. Shortening the AV interval resulted in pacing with a short QT interval. Further reduction of the AV interval resulted in a longer QT interval up to a point where the QT interval became stable. This point, the bending point in the plot of measured QT interval versus shortened AV intervals, coincided with the point of FVC. The relation of the QT-AV interval plot and the point of fusion was comparable when lengthening the AV interval at a 30 beats/min faster stimulation rate. CONCLUSION: The bending point in the QT interval versus AV interval plots showed a good correlation with the FVC and fusion points observed on ECG. The results suggest that automatic discrimination between fusion and full capture using QT interval measurements may be feasible.

• Tolerance and effects of almokalant, a new selective Ik blocking agent, on ventricular repolarization and on sino-atrial and atrioventricular nodal function in the heart: a study in healthy, male volunteers utilizing transesophageal atrial stimulation.

  Authors: B Darpö, O Almgren, R Bergstrand, C Bäärnhielm, C Gottfridsson, B Sandstedt, N Edvardsson

  Journal of cardiovascular pharmacology. 06/1995; 25(5):681-90.

  Almokalant, (4-(3-ethyl(3-propylsulfinyl)propyl)amino)-2-hydroxy-propoxy)- benzonitrile), is a newly developed Ik channel blocker that exhibits pure class III effects. Using a noninvasive approachAlmokalant, (4-(3-ethyl(3-propylsulfinyl)propyl)amino)-2-hydroxy-propoxy)- benzonitrile), is a newly developed Ik channel blocker that exhibits pure class III effects. Using a noninvasive approach with transesophageal atrial stimulation (TAS), we wished to identify the dose of almokalant, given as an intravenous bolus infusion, that prolonged ventricular repolarization in the healthy human heart to an extent of potential clinical interest. Furthermore, we defined the electrophysiological effects of this dose on the heart, as well as the pharmacokinetics, safety, and tolerance throughout a wide dosing range. In the titration part, increasing doses were given to identify the dose that produced a reproducible QTend prolongation of approximately 20%. This dose (12.8 mumol) was then given in a placebo-controlled, double-blind, cross-over fashion. In the double-blind part, almokalant significantly prolonged the QTend intervals during sinus rhythm and during TAS at 100 beats/min and increased the effective refractory period of the atria (AERP). There was no alteration in either the cardiac conduction (PQ and QRS), or blood pressure (BP) sinus node function, or the ERP of the atrioventricular (AV) node. Therefore, almokalant exhibited pure class III effects with no signs of beta-blockade or unwanted hemodynamic effects. The plasma concentration-time curve showed a biexponential decrease with a terminal half-life (t1/2) of approximately 3 h. There was a large interindividual variation in the plasma concentration at the end of infusion, Cmax. This variability diminished considerably 60 min after infusion, and the pharmacokinetic characteristics studied appeared to be proportional to the dose. The drug was well tolerated, and the only side effect noted was a brief metallic taste after a dose of 25.6 mumol. Corresponding to high plasma peak values, T-wave morphology changes of short duration were observed, sometimes with the development of pronounced, biphasic T waves.

• [Catheter ablation in supraventricular tachycardia. Only few complications with the use of radiofrequency energy]

  Authors: B Darpö, H Walfridsson, C Gottfridsson, B Sandstedt, N Edvardsson

  Läkartidningen. 01/1995; 91(50):4739-45.

• [Catheter ablation with radiofrequency current--a successful curative treatment of tachyarrhythmia]

  Authors: B Darpö, C Gottfridsson, B Sandstedt, N Edvardsson

  Läkartidningen. 01/1993; 89(49):4275-8, 4281.

• [Transesophageal atrial stimulation--a new method for discovering paroxysmal supraventricular tachycardia]

  Authors: B Darpö, C Gottfridsson, B Sandstedt, N Edvardsson

  Läkartidningen. 05/1992; 89(18):1571-6.

• Early treatment with thrombolysis and beta-blockade in suspected acute myocardial infarction: results from the TEAHAT Study.

  Authors: M Risenfors, J Herlitz, C H Berg, M Dellborg, G Gustavsson, C Gottfridsson, M Lomsky, K Swedberg, A Hjalmarsson

  Journal of internal medicine. Supplement. 02/1991; 734:35-42.

  Independent trials of early administration of beta-blockers and thrombolytic agents have shown beneficial effects on both short- and long-term prognoses in acute myocardial infarction (AMI). TheIndependent trials of early administration of beta-blockers and thrombolytic agents have shown beneficial effects on both short- and long-term prognoses in acute myocardial infarction (AMI). The effects of a combination of the two strategies have not been thoroughly documented. Three hundred and fifty-two patients, of less than 75 years of age, with chest pain indicative of AMI, and onset less than 2 h and 45 min before first examination, were randomized to treatment with rt-PA or placebo. All patients without contraindication were given intravenous metoprolol 15 mg acutely and then 200 mg orally daily. Treatment was started either at the prehospital stage or in hospital. Thirty-seven per cent of patients had contraindications to beta-blockade, the most frequent of which were heart rate less than 60 beats min-1 and hypotension. The remaining 63% were given intravenous beta-blockade. No side-effects of metoprolol, alone or in combination with rt-PA, were observed during the prehospital phase. Overall, toleration of the treatment was good. Reduction in enzymatically estimated infarct size by rt-PA was more pronounced in patients who were also treated with metoprolol (41%, P less than 0.001) than in those with contraindications to beta-blockade (15%, NS). Patients who were also treated with metoprolol also had a lower incidence of Q-wave infarctions, congestive heart failure and ventricular fibrillation than those who were not given intravenous beta-blockade. In conclusion, toleration of intravenous administration of rt-PA and metoprolol was good, and this was also the case in the prehospital phase.(ABSTRACT TRUNCATED AT 250 WORDS)

• [Anti-arrhythmia agents after myocardial infarction should be used with caution]

  Authors: R Bergstrand, B O Fredlund, C Gottfridsson, A Sigurdsson, K Swedberg, L Wilhelmsen

  Läkartidningen. 10/1989; 86(38):3127-8.