-
[show abstract]
[hide abstract]
ABSTRACT: The relationship between syncope and psychiatric disorders is little investigated. This study evaluated the prevalence of psychiatric diseases and prognostic outcome in patients with recurrent unexplained syncope.
After an inconclusive standard diagnostic work-up for syncope, including head-up tilt testing, a psychiatric evaluation was offered to 50 consecutive patients with recurrent syncope. The evaluation was accepted by 26 patients (77% females, 36 +/- 16 years) and refused by 24 (63% females, 50 +/- 19 years). A psychiatric disorder was diagnosed in 21 (81%) patients: 12 had depression, four panic attacks, two general anxiety, and three a somatization disorder. Only five patients showed normal psychosocial function. Of the patients with psychiatric disorders four accepted psychiatric care, such as psychotherapy and/or pharmacotherapy; 17 patients refused treatment. During 6 months of follow-up no patient under psychiatric care had syncope, while all patients without psycho- or pharmacotherapy had recurrent syncopal events. In these patients the median of syncopal episodes was three in a 6 months interval before and after clinical assessment. Patients who refused both psychiatric evaluation and therapy continued to experience syncope as before.
In patients with recurrent unexplained syncope psychiatric alteration is common. However, patients seldom accepted a psychiatric evaluation and treatment.
Europace 11/2001; 3(4):311-6. · 1.98 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Three-dimensional electroanatomic (CARTO) activation mapping of the cavotricuspid isthmus can be helpful to guide atrial flutter ablation, but to date has not been investigated in comparison to conventional strategies. The aim of the present study was to assess the efficacy of the CARTO navigation system, especially with respect to the fluoroscopy time required for successful atrial flutter ablation.
Eighty patients with recurrent common-type atrial flutter were randomly assigned to temperature-controlled radiofrequency (RF) catheter ablation, either guided by conventional criteria (group 1) or additionally oriented on electroanatomic mapping (group 2). In all patients, similar multipolar catheters were inserted into the coronary sinus and placed at the tricuspid annulus, respectively. In group 2, positioning of the mapping electrode and delivery of RF pulses within the cavotricuspid isthmus was mainly oriented on the CARTO map to achieve the most linear and continuous RF lesions. Abolition of intra-atrial conduction verified by conventional criteria (group 1) and electroanatomic mapping (group 2) could be verified in all patients. The overall number of RF pulses (group 1: 16.7+/-6.5; group 2: 13.2+/-5.3) and mean procedure duration (group 1: 172.5+/-47.4 min; group 2: 169.3+/-47.3 min) were not different between the two groups, but mean fluoroscopy time was significantly shorter when the CARTO technology was used (group 1: 29.2+/-9.4 min; group 2: 7.7+/-2.8 min; P = 0.0001). Recurrence of atrial flutter was observed in 3 (9%) patients in each group after a mean follow-up of 8.5+/-2.8 months.
Atrial flutter can be abolished effectively using the conventional technique as well as oriented on electroanatomic mapping. However, overall X-ray exposure can be significantly reduced by the CARTO-guided approach without prolongation of procedure duration.
Journal of Cardiovascular Electrophysiology 12/2000; 11(11):1223-30. · 3.06 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: We conducted a prospective, multicenter, randomized comparison of implantable cardioverter-defibrillator (ICD) versus antiarrhythmic drug therapy in survivors of cardiac arrest secondary to documented ventricular arrhythmias.
From 1987, eligible patients were randomized to an ICD, amiodarone, propafenone, or metoprolol (ICD versus antiarrhythmic agents randomization ratio 1:3). Assignment to propafenone was discontinued in March 1992, after an interim analysis conducted in 58 patients showed a 61% higher all-cause mortality rate than in 61 ICD patients during a follow-up of 11.3 months. The study continued to recruit 288 patients in the remaining 3 study groups; of these, 99 were assigned to ICDs, 92 to amiodarone, and 97 to metoprolol. The primary end point was all-cause mortality. The study was terminated in March 1998, when all patients had concluded a minimum 2-year follow-up. Over a mean follow-up of 57+/-34 months, the crude death rates were 36.4% (95% CI 26.9% to 46.6%) in the ICD and 44.4% (95% CI 37.2% to 51.8%) in the amiodarone/metoprolol arm. Overall survival was higher, though not significantly, in patients assigned to ICD than in those assigned to drug therapy (1-sided P=0.081, hazard ratio 0.766, [97.5% CI upper bound 1.112]). In ICD patients, the percent reductions in all-cause mortality were 41.9%, 39.3%, 28. 4%, 27.7%, 22.8%, 11.4%, 9.1%, 10.6%, and 24.7% at years 1 to 9 of follow-up.
During long-term follow-up of cardiac arrest survivors, therapy with an ICD is associated with a 23% (nonsignificant) reduction of all-cause mortality rates when compared with treatment with amiodarone/metoprolol. The benefit of ICD therapy is more evident during the first 5 years after the index event.
Circulation 09/2000; 102(7):748-54. · 14.74 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: To assess whether rapid high voltage ventricular pacing can also induce atrial fibrillation, and whether the induction of atrial fibrillation during ventricular fibrillation conversion testing is related to the patient's heart disease.
Prospective study of 50 patients who received the dual chamber implantable cardioverter-defibrillator (ICD) Ventak AV II DR (Guidant) as a first implant. This device can record atrial activity even during a ventricular fibrillation episode and can induce atrial fibrillation by rapid atrial bursts.
Frequency of atrial fibrillation after induction of ventricular fibrillation; clinical characteristics of patients with and without induced atrial fibrillation; frequency of atrial fibrillation induced by rapid atrial bursts during predischarge testing.
Atrial fibrillation was observed in 40 of the 217 ventricular fibrillation episodes (18%) that could be detected immediately after delivery of high voltage pacing. The biphasic ICD shock for termination of ventricular fibrillation also terminated the atrial fibrillation in all cases. The 40 episodes of simultaneous atrial and ventricular fibrillation occurred in 18 patients (36%). The distribution of the clinical characteristics of the patients and the inducibility of atrial fibrillation during predischarge testing were similar in those with and without induced atrial fibrillation.
Rapid high voltage ventricular pacing frequently induces atrial fibrillation, which was terminated by the subsequent biphasic ICD shock. The induction of atrial fibrillation seems to be a non-specific phenomenon, unrelated to the clinical status of the patient.
Heart (British Cardiac Society) 03/2000; 83(2):178-80. · 4.22 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: The purpose of this study was to use the electrogram storage capabilities of the implantable cardioverter-defibrillator (ICD) to categorize any arrhythmic event during follow-up in a group of patients who had survived an episode of ventricular fibrillation (VF) and to possibly identify clinical predictors of future arrhythmic events.
Little is known about the electrophysiologic characteristics of ventricular arrhythmias recurring during follow-up in survivors of VF as the sole documented arrhythmia at the time of resuscitation.
Forty patients (58+/-10 years; 73% men; left ventricular ejection fraction 42+/-18%; 70% with coronary artery disease) who had survived an episode of VF and subsequently received an ICD capable of intracardiac electrogram recording and storage were followed for 23+/-11 months. In all patients, the arrhythmogenic substrate was investigated by means of programmed electrical stimulation (PES).
Among the 40 patients, 41 episodes of ventricular arrhythmias were documented in 13 patients (33%): 36 episodes of ventricular tachycardias (VT) were recorded in 11 patients (28%) and 5 episodes of VF were recorded in the remaining 2 patients (5%). Age, gender, cardiac disease and left ventricular ejection fraction failed to distinguish between patients with clinical recurrences and patients without. The sensitivity, specificity and positive accuracy of PES were 29%, 63% and 46%, respectively, for prediction of ventricular arrhythmia recurrence; 45%, 70% and 36%, respectively, for prediction of VT; and 50%, 98% and 50%, respectively, for prediction of VF during follow-up.
In survivors of VF receiving ICD therapy, VT is the most common ventricular arrhythmia recorded on device-incorporated electrograms during follow-up. This finding, associated with the relatively well-preserved ventricular function, may account for the ability of these patients to survive at time of the index arrhythmia; the use of antitachycardia pacing as a modality to treat arrhythmia recurrences may contribute to reduce the incidence of shock during follow-up in these patients.
Journal of the American College of Cardiology 12/1998; 32(6):1724-30. · 14.16 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Sodium channel blockers and class III antiarrhythmic compounds, as well as beta blockers, have been used in preventing recurrences of sudden cardiac death. In recent years, implantable cardioverter-defibrillators (ICDs) have been used increasingly, but no data from randomized trials comparing antiarrhythmic drug and ICD therapy have been reported in this setting. In 1987, the Cardiac Arrest Study Hamburg (CASH), a prospective, randomized trial, was initiated to compare metoprolol, amiodarone, propafenone, and ICD implantation in patients surviving sudden cardiac death due to documented ventricular tachycardia and/or ventricular fibrillation. The details of the study design and preliminary results are presented herein. The primary endpoint of the study is total mortality. The data reviewed in March 1992, representing a mean follow-up period of 11 months, indicated no significant differences among patients randomized to metoprolol, amiodarone, and ICDs. However, there was a significantly higher total mortality and cardiac arrest recurrence in patients randomized to propafenone compared with those randomized to the ICD treatment limb. The study continues with the deletion of the propafenone treatment limb.
The American Journal of Cardiology 12/1993; 72(16):109F-113F. · 3.37 Impact Factor
-
Pacing and Clinical Electrophysiology 04/1993; 16(3 Pt 2):552-8. · 1.35 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Dental amalgam has been considered to have adverse side effects on the immune system. Reports have been contradictory, indicating both an increase and a decrease in peripheral blood lymphocyte counts associated with amalgam restorations. We investigated two groups of patients, one of which was treated with amalgam restorations for the first time. In the other group, all existing amalgam fillings were removed. Prior to and after treatment, we determined the absolute and relative numbers of granulocytes, lymphocytes, monocytes, T cells, B cells, cytotoxic T cells, helper T cells and natural killer cells. In addition, functional investigations of T cells were performed. We failed to find any effect of amalgam restorations on the immune system in terms of the parameters investigated.
The Clinical Investigator 10/1992; 70(9):728-34.
-
[show abstract]
[hide abstract]
ABSTRACT: Most of what is known regarding adrenergic control of mammalian pineal functions has been derived from investigations with rodents. In an effort to provide a new animal model for pineal research, the bovine pineal gland was selected for practical and theoretical reasons. Bovine pinealocytes in monolayer culture were first characterized in terms of optimal culture conditions, i.e. medium requirements, cell density, preincubation duration and stimulation times. In Dulbecco's minimum essential medium/Ham's F12 medium, 2 x 10(5) cells per well preincubated for 6 days and stimulated for 8 h resulted in large increases in melatonin (mel) release (15- to 17-fold) after adrenergic stimulation. Likewise, cAMP accumulation within 10 min of stimulation increased 4- to 8-fold. (Bu)2cAMP (10(-5)-10(-3) M) produced a significant elevation in MEL secretion. Neither adrenergic dose-response studies, adrenergic antagonist studies nor experiments in which alpha- and beta-agonists were added together provided any evidence for a positive alpha/beta synergism on either MEL release or cAMP accumulation by bovine pinealocytes. This culture system should prove useful for identifying species differences in the signal transduction mechanisms underlying the activation of MEL secretion in the mammalian pineal.
Endocrinology 12/1991; 129(5):2655-62. · 4.46 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Dental amalgam has been considered to have adverse side effects on the immune system. There are controversial reports, which indicate an increase as well as a decrease in peripheral blood lymphocyte counts due to amalgam fillings. We investigated 2 groups of patients: one group was treated with amalgam restorations for the first time. In the other group all previous amalgam fillings were removed. Before and after treatment we determined the absolute and relative numbers of granulocytes, lymphocytes, monocytes, T cells, B cells, suppressor T cells, helper T cells and NK cells. In addition, functional investigations of T cells were performed. In conclusion, we could not find any effect of amalgam restorations on the immune system regarding the investigated parameters.
Deutsche zahnärztliche Zeitschrift 09/1991; 46(8):544-7.
