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Biomedical subjects

A Goicolea de Oro

Publications and source records attributed to A Goicolea de Oro.

6 recordsLinked to original sources
PubMed1998

[Informed consent in cardiology. The Committee on Informed Consent of the Commission on Professional Matters of the Sociedad Española de Cardiología].

In the last thirty years, the clinical relationship between physicians and patients has been rather modified. There are several factors that have contributed to this change: a) New ways to execute medical practises, specially referred to the development of new techniques; b) Cultural changes in our western society, mainly in the mediterranean area, where there has been progress in the recognition of patients' autonomy to decide about their own lives, health and their own bodies; c) The increasing number of lawsuits, complaints and judgements about the problems that clinical information involves, particularly the informed consent in clinical practise. We consider it necessary to make an extensive and deep discussion from all of the areas in Medicine and Law, to analyze the different ethical and legal parts of the informed consent. For that reason the Spanish Society of Cardiology offers their members a basic document in order to reflect about these facts, developing arguments, justifications and supports. This document has also considered models, conditions to their applicability according to Spanish law, and the experience we have had. Finally, there is a list of diagnostic procedures and interventional practises in cardiology that might be preceded by a written informed consent document. We considered them by the name of Spanish Society of Cardiology recommendations.

Cardiology↗
PubMed1997

[Results of long-term permanent atrial stimulation in sick sinus disease].

INTRODUCTION: AAI is the pacing mode recommended in patients with sinus node dysfunction (SND) but is the less used in our country. Progression to high grade atrioventricular block (AVB) is argued as the reason to implant VVI or DDD pacemakers. We used AAI pacemakers in patients with SND only if Wenckebach AVB appeared at atrial pacing rates > or = 120 beats/min before implantation. PATIENTS AND METHODS: A series of 45 patients with permanent atrial pacemaker (AAI-PM) systems, were prospectively followed and retrospectively analyzed to investigate the incidence of atrioventricular (AV) conduction disturbances and chronic atrial tachyarrhythmias. AAI-PM were implanted in patients with sinus node dysfunction (SND) in the absence of bundle branch block, only if Wenckebach AV block appeared at atrial pacing rates > or = 120 beats/min. Four patients were lost during follow-up. In 41 patients (23 males, mean age 68 +/- 12 years) the mean follow-up time was 56 months (10 to 110). There was one case of lead failure but no case of dislodgement. RESULTS: 28 of the 41 patients are still successfully paced in AAI mode after a mean of 68.5 months (44-110). Five patients presented chronic atrial fibrillation at a mean of 23 months (10-39) after PM implantation and remained chronically in this situation. Of these, 4 patients had paroxysmal atrial fibrillation documented before PM implantation. Eight patients died during follow-up (range 10-78 months post PM implantation) at mean age 84 years. Causes of death were noncardiovascular in 5 patients, and a cerebrovascular accident in 3 patients. One patient on digoxin and amiodarone had asymptomatic Wenckebach AV block during night sleep. The AV conduction normalized after cessation of drug therapy. Progression to high degree AV block was not documented in any patient. CONCLUSION: AAI is a reliable and safe mode of pacing in patients with SND. If appropriate indications for AAI pacing are followed, progression to high degree AV block is rare and the need to implant additional ventricular lead seems unlikely.

Adult↗
PubMed1993

[Chronotropic competence in patients with the sick sinus syndrome wearing AAI or DDD pacemakers].

The prevalence of chronotropic incompetence in patients with sinus node disease (SND) is not well defined. To assess this, we evaluated 18 patients (7 men, 11 women; mean age: 64 +/- 11) with SND and permanent pacemakers (AAI/DDD) with Holter monitoring and treadmill stress test. Only 2 patients received active cardiac drugs (1, L-dopa an 1 propafenone). The treadmill tests results were compared with a control group of 15 men and 18 women (mean age: 66 +/- 5, p = NS) without organic heart disease. During ambulatory activity all pacemaker patients increased their own cardiac rate to a value higher than the programmed basic pacemaker rate. In 8 patients the maximal rate attained was over 100/min (mean 95 +/- 19/min). The maximal rate during treadmill test in pacemaker patients was 131 +/- 25 (control group 138 +/- 14, p = NS). Exercise tolerance in METs was similar in pacemaker patients (5.2 +/- 2.6) and in controls (5.8 +/- 1.2) (p = NS). Two pacemaker patients (12%) didn't reach 100/min during stress test. Most patients with SND and permanent pacemakers (AAI/DDD) are able to increase cardiac rate during exercise. Rate responsive pacing (AAIR/DDDR) should be limited to a minority of patients with true chronotropic incompetence.

Aged↗
PubMed1990

[Permanent atrial stimulation (AAI) in the sick sinus syndrome].

A consecutive series of 18 patients (5 males, 13 females, mean age +/- DS 65 +/- 12 and 66 +/- 13 years, respectively, and mean +/- DS Wenckebach point of 162 +/- 20 ppm) given arterial pacemakers for sinus node dysfunction (SND) were followed to study the incidence of lead failure, atrioventricular conduction disturbances and chronic atrial tachyarrhythmias. The mean follow up time +/- SD was 18 +/- 10 months. There was not lead dislodgement. Chronic voltage output was reduced to 2.5 volts in 73% of patients because of a reduced chronic pacing threshold. One patient presented acute transient rise of pacing threshold and temporary loss of atrial detection. Progression to AV block was not documented. One patient had asymptomatic Wenckebach AV block during the night while on digoxin plus amiodarone. The AV block disappeared after cessation of drug therapy. Patients with previous episodes of paroxysmal atrial fibrillation did not presented the arrhythmia during follow up, while 75% of patients with previous atrial flutter presented the arrhythmia. None of the patients had systemic embolism. In conclusion, AAI pacing is a reliable and safe mode of pacing in patients with SND.

Aged↗
PubMed1985

Rate-responsive pacing: clinical experience.

Single chamber, rate-responsive pacing is emerging as a new modality in cardiac pacing and in the near future, dual chamber rate-responsive pacing may be the optimal solution for most pacemaker patients. In this report we describe our short- and long-term clinical experience with two different rate-responsive pacemakers: the RS4, an asynchronous atrial sensing ventricular pacemaker, and the TX-pacemaker, which senses the evoked QT after a ventricular paced beat, as an indicator of metabolic demand. Both systems use a single ventricular lead. Nine patients received RS4 and 10 patients received TX units. All of these patients had AV block and good ventricular function except for three patients with sinus node disease in the TX group. Between 1 and 3 months after implantation, a 24-hour Holter monitoring was performed, during which two maximal symptom-limited treadmill exercise tests (Bruce protocol) were conducted in VVI (70 bpm) and rate-responsive modes, in a random fashion. The mean follow-up was 25 months in RS4 group and 10 months in TX group. Significant improvements in patient exercise tolerance were found in the rate-responsive mode (9.0 vs. 6.6 METs in VVI) with similar results in both groups (RS4 and TX) despite higher ventricular pacing rates in the TX group (121 bpm vs. 102 bpm in RS4). An autolimited rate-responsive pacemaker-mediated tachycardia, induced by retrograde ventriculo-atrial conduction, was observed in a patient with an RS4.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗