[Show abstract][Hide abstract] ABSTRACT: Has been reported that patients exhibiting prolonged paced QRS duration tend to have more serious heart disease, and the paced QRS duration can be an effective indicator of impaired left ventricular function. However, the acute and chronic hemodynamic effects of paced QRS duration and pacing sites during right ventricular (RV) pacing remain unknown.
A total of 14 patients who underwent electrophysiologic study for paroxysmal supraventricular tachycardia were examined. RV pacing was performed at 10 different sites with cycle lengths of 600 ms and 500 ms utilizing a 6-7F deflectable quadripolar electrode catheter. Systolic, diastolic, and mean blood pressures during pacing were measured once the blood pressure was stabilized.
During RV pacing, blood pressures (systolic/diastolic/mean) decreased. The change of post-pacing QRS duration and pre-pacing the systolic blood pressure (SBP) were greater in the group with paced QRS duration. The differences overall were greater than 140 ms. The SBP decrease during pacing was larger in the group exhibiting paced QRS duration of greater than 140 ms. The SBP decrease during pacing showed relation to QRS duration during pacing (r = 0.500, p = 0.001), the change of QRS duration post-pacing (r = 0.426, p = 0.001), and SBP during sinus rhythm (r = 0.342, p = 0.001) on linear correlation analysis. The pacing site, on the other hand, did not affect acute hemodynamic changes during pacing.
Ventricular pacing of less than 40 ms at the area of paced QRS duration is recommended.
Preview · Article · Apr 2005 · The Korean Journal of Internal Medicine
[Show abstract][Hide abstract] ABSTRACT: BACKGROUND AND OBJECTIVES: Primary percutaneous coronary intervention (PCI) has been found to be superior, in terms of hospital mortality and long-term follow-up, compared with thrombolytic therapy for acute myocardial infarction (AMI). However, the clinical benefits of primary PCI have not been precisely evaluated in elderly patients.
Preview · Article · Jan 2005 · Korean Circulation Journal
[Show abstract][Hide abstract] ABSTRACT: A 55-year old male presented with chest and abdominal pain for four hours. One day prior to admission he had received chemotherapeutic agents comprising 130 mg cisplatin and 5,200 mg 5-Fluorouracil for nasopharyngeal carcinoma. EKG showed ST elevations in the leads II, III and aVF. The levels of cardiac enzymes were elevated [creatine kinase (CK) 1129 U/L, CK-MB 180 U/L, troponin T 1.23 ng/mL and troponin I 23.29 ng/mL]. Urokinase was administered at the emergency room, but the patient's chest pain continued with persistent ST segment elevations. Urgent coronary and renal angiograms revealed thrombotic occlusive lesions in the distal right coronary and right renal arteries. Percutaneous transluminal renal angioplasty using 6.0x20 mm balloon was performed for the renal artery. However, filling defects and distal renal flow were not improved and so Abciximab (ReoPro(r)) was administered. Follow-up coronary and renal angiograms on the fifth hospital day showed no filling defects with good distal flow in both right coronary and renal arteries.
[Show abstract][Hide abstract] ABSTRACT: Since 1987, coronary stents have changed the pattern of practice of interventional cardiology, by reducing the complications and improving the clinical outcomes. However, coronary stent restenosis still remains a significant clinical problem in the field of interventional cardiology. The aim of this trial was to compare the clinical efficacy of a rotational atherectomy (ROTA), with that of a plain old balloon angioplasty (POBA), in patients with coronary stent restenosis.
[Show abstract][Hide abstract] ABSTRACT: A 28-year old male presented with chest pain of two hours duration. He had histories of 10 years smoking and 2 years of nephrotic syndrome, due to minimal change disease. His EKG showed marked ST segment elevations in the V3-6, I, II, III and aVF leads. The levels of cardiac enzymes were increased (CK: 481 U/l, CK-MB: 96 U/l and Troponin I: 4.8 ng/mL). The prothrombin and activated partial promboplastin times were normal. Accelerated tissue type plasminogen activator (100 mg) was administered at the emergency room, but his chest pain continued, with persistent ST segment elevations. An urgent coronary angiograph revealed huge multiple filling defects, suggestive of thrombi in the proximal left anterior descending artery (LAD), with thrombolysis in the myocardial infarction (TIMI) flow. A rescue percutaneous coronary intervention was performed using repeated angioplasties with a 3.0 mm balloon. However, the filling defects and distal LAD flow did not improve. We administered Abciximab (ReoPro(r)), and the LAD flow improved to a TIMI III flow, with resolution of the thrombus in the LAD. His clinical course was uneventful after discharge, and a left coronary angiogram, at the 6-month follow-up, showed no filling defects, with the TIMI III flow maintained.