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Biomedical subjects

A Sh Revishvili

Publications and source records attributed to A Sh Revishvili.

At least 19 recordsLinked to original sources
PubMed2006

[Implanted cardioverters-defibrillators in the treatment of arrhythmias and prevention of sudden death].

AIM: To present 15-year experience in use of implantable cardioverters-defibrillators (ICD) in patients with life threatening arrhythmias and a high risk of sudden cardiac death (SCD). MATERIAL AND METHODS: A total of 151 patients (116 males and 35 females aged 12-75 years) with life threatening arrhythmias and ICD were studied. RESULTS: There were neither complications nor lethality. Electrocardiotherapy was performed in 89 (58.9%) patients 4.5 +/- 9.4 months, on the average, after ICD implantation. Attacks of ventricular tachycardia (VT) were arrested by antitachycardia stimulation (974 episodes, 37.5 +/- 92.5 per patient, on the average). Effective cardioversion in VT was observed in 63 (41.7%) cases. Episodes of rapid ventricular tachycardia and ventricular fibrillation were stopped by defibrillation shocks in 28 (18.5%) patients. Additional surgical interventions were made in 3 patients because of electrodes dislocation, in 1--because of electrode brakage and in 1--suppuration of the bed. Fifteen patients (9%) died during follow-up because of cardiac failure (n = 13), cancer (n = 1), unknown cause (n = 1). CONCLUSION: Clinical application of ICD is not only treatment of arrhythmia and prevention of SCD but it is also a method of diagnosis, collection and accumulation of information about the disease course.

Adolescent↗
PubMed2005

[A new view of anatomic substrate, electrophysiological mechanisms of atrial fibrillation, and results of interventional treatment].

Literature data on anatomic and electrophysiological properties of pulmonary veins (PVs) are very scarce. The study included an investigation of 20 human autopsy hearts with and without cardiovascular pathology. In addition, biopsy samples from the right superior PV were taken from 5 patients with atrial fibrillation (AF) for ultrastructural study. The investigation found myocardial sleeves (MS) in 86.3% of cases, an additional PV between right PVs--in 15%, a collector type of superior and inferior PV--in 25% of cases. MS were situated on the adventitial side of PVs; along the whole length of the PVs the MS myocyte fascicles ran in different directions. Local changes, such as productive myocarditis, fibrosis and fibro-lipomatosis, were observed in MS of PV of patients with AF. 106 patients (80 of whom were male; middle age 42.9 +/- 12.5 years) with symptomatic AF underwent clinical examination. Electrophysiological features of the PVs were evaluated in 30 patients. Effective and functional refractory periods of PVs were found to be shorter than those of the left atrium and non-arrhythmogenic PVs. Radiofrequency ablation (RA) with application of electrophysiological criteria proved to be effective in all patients with frequent ectopy from PVs. The use of electroanatomical mapping allowed successful RA in 82% of patients with persistent and chronic AF. The study demonstrates that the changes in MS of PV, discovered by means of light and electron microscopy, as well as their complex three-dimensional morphological structure may cause and maintain AF. Very distinct electrophysiological features, found in AF patients, probably play a major role in arrhythmogenicity.

Adolescent↗
PubMed2002

[Dynamics of parameters of heart rate variability in patients with ischemic heart disease after direct myocardial revascularization].

AIM: To study dynamics of parameters of heart rate variability (HRV) in patients with ischemic heart disease after direct myocardial revascularization. MATERIAL AND METHODS: Electrocardiography (ECG), 24 hour Holter ECG with spectral and temporal analysis of 24-hour HRV, as well as echocardiography (Echo) and stress-Echo were carried out in 24 patients with ischemic heart disease before, in 2-4 weeks and 2 months after surgery. Healthy persons of the same age (n=20) were used as controls. RESULTS: Prior to operation HRV in all patients was lower than in controls. In 2-4 weeks after coronary artery bypass grafting (CABG) further lowering of HRV parameters occurred. In 2 months after CABG HRV parameters in patients without complications were similar to preoperative values but remained lower than in controls.

Adult↗
PubMed1993

[The electrophysiological diagnosis and surgical treatment of atrial flutter].

From 1982 to the late 1990 thirty-three patients with tachysystolic atrial fibrillation refractory to preventive antiarrhythmic therapy were examined and operated on. Invasive electrophysiological investigation was a must in the preoperative examination. The "entrainment" and "adaptation" effects of the refractory periods of different parts of the atria were estimated depending on the duration of the basic cycle of pacing. After provoking atrial flutter paroxysm the place of the early appearance of A spike was determined and endocardial mapping was performed. During intraoperative mapping, the data of low-amplitude and fragmented activity were processed by a computer; the sequence of electric activation of the atria was determined on flutter. 20 transthoracic operations with extracorporeal circulation were made. Of these, there were 7 operations of laser or cryogenic isolation of the AB node, 30 of laser photo ablation, and 9 of cryodestruction of the arrhythmogenic areas. In a female patient, resection of the terminal crest and sinoatrial node followed by implantation of a pacemaker was performed in the AAI mode. Closed operations involved both transvenous electrodestruction of the arrhythmogenic areas (5 patients) and destruction of the His bundle with the development of complete transverse block and implantation of the pacemaker in the VVI mode. The best results were attained in young persons with Type I idiopathic atrial flutter where areas of fragmented and low-amplitude activity could be accurately specified.

Adolescent↗
PubMed1992

[Surgical treatment of supraventricular tachyarrhythmias using laser].

Much importance is attached lately to the use of lasers in surgical treatment of tachyarrhythmias. The advantages of the laser radiation are as follows: the possibility of using it on a contracting heart, its exact and selective effect, infliction of even damages in preservation of the structure, reduction of damage to the myocardium as a whole. At the Bakulev Institute of Cardiovascular Surgery, USSR AMS, 52 operations were carried out in the management of supraventricular tachyarrhythmias by laser radiation: 27 operations for laser isolation of the atrioventricular node, 15 operations for laser isolation of the atria and bases of the pulmonary veins (11 in combination with laser isolation of the atrioventricular node), 3 operations for ablation of ectopic foci in the atria and ventricles, 4 operations for ablation of the bundle of His, and 3 operations for removal of Maheim's nodoventricular tract. Among the patients who were operated on, 12 had atrial flutter, 21--atrial fibrillation, 11--paroxysmal atrioventricular nodal tachycardia, 5--ectopic supraventricular tachycardia, and 3 patients had paroxysmal tachycardia due to the presence of Maheim's nodoventricular tract. The method of laser isolation of the atrioventricular node was developed. It is performed on a working heart under conditions of normothermal extracorporeal circulation by Nd-YAG laser radiation under electrophysiological control. Antegrade conductivity was reduced to 420-510 msec. Among 56 patients who underwent operation 39 had sinus rhythm, 10 had Degree II-III block, and 7 patients had a recurrence.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1990

[Evaluation of the results of epicardial electric pulse destruction of the bundle of Kent: immediate and late results].

The authors assessed the outcomes of an epicardial electrical pulse destructive operation on Kent's bundle in 170 patients with the Wolff-Parkinson-White syndrome. The operation consisted in generating an electrical stimuli train of a power of 50-250 J along the fatty tenial margin of the atrioventricular sulcus, which damaged or isolated Kent's bundle. By refining the indications for application of the method, the authors succeeded in achieving 98% efficacy in abolishing the Kent bundle conduction in the absence of deaths in the latter group of patients. The technique was found to be indicated in lateral bundle localizations, except right anterolateral localizations when atrioventricular conduction disturbances may be present. Myocardial changes occurring after destruction caused no hemodynamic abnormalities and were not associated with coronary artery lesions. Increasing the force of intact myocardial contraction fully compensated a slight segmental ejection fraction deficiency at the site of destruction.

Adult↗
PubMed1990

[Electrophysiological diagnosis and surgical treatment of supraventricular tachycardia].

In 1981-1988, 515 operations were made in patients with supraventricular tachycardias (SVT) refractory to preventive antiarrhythmic therapy at the A. N. Bakulev Institute of Cardiovascular Surgery, USSR Academy of Medical Sciences. Nodal tachycardias were observed in 51 (10%) patients, ectopic SVT were found in 32 (6%), atrial fibrillation and flutter were seen in 140 (27%), and preexcitation syndromes were present in 292 (57%). The current surgical therapy of SVT returns to socially active lifestyle, abolishes tachycardias and eliminates sudden death in 97% of patients with parietal accessory pathways and atrial fibrillation. Transvenous fulguration is the method of choice in artificially inducing atriovetricular block (97% positive outcomes), in radically abolishing nodal tachycardias (100%), and Type I idiopathic atrial flutter (88%).

Adolescent↗
PubMed1990

[Surgical treatment of tachycardia in children].

Based on the outcomes of surgical treatment in 127 children suffering from tachycardias, three clinical groups were identified: Group 1: an uncomplicated course; Group 2: tachycardias concurrent with congenital heart disease; Group 3: life-threatening tachyarrhythmias. The results of surgical treatment were the following by the groups: Group 1 showed its efficacy in 96.5% and a tachycardial relapse in 3.5%, Group 2 displayed it in 81.0%, deaths in 19.0%, Group 3 exhibited it in 93%, deaths in 7%. In the surgical treatment of the Wolff-Parkinson-White syndrome, the method of choice is epicardial fulguration of the accessory atrioventricular pathway (100% versus 89.4% for the W. Sealy procedure).

Adolescent↗
PubMed1990

[Results of surgical treatment of ventricular tachycardia].

Surgical treatment is the method of choice in patients with ventricular tachycardia refractive to drug therapy. Fifty-six patients with ventricular tachycardia of various genesis were examined and separated into two groups according to the main heart disease. Group 1 was formed of patients with ischemic heart disease. In 16 of the 17 patients of this group disorders of left-ventricular contractility were revealed, the ejection fraction varied from 18 to 56% (average 32 +/- 13.8%). The attacks of ventricular tachycardia in patients of group 1 were characterized by an extremely severe course and cardioversion had to be resorted to repeatedly in order to relieve them. Endo- and epicardial mapping revealed localization of the arrhythmogenic focus on the boundary of the myocardial area involved in fibrosis. Surgical treatment was successful in 72% of cases in this group. Group 2 included patients with ventricular tachycardia of noncoronary genesis. In electrophysiological examination tachycardia could not be induced in 6 patients of this group. In 12 of 39 patients attacks of tachycardia were not attended by hemodynamic disorders. Contractility of the left-ventricular myocardium was disturbed only in 14 (36%) patient. The arrhythmogenic focus was in the right ventricle in 22 patients and in the left ventricle in 11 patients. Operation was performed on 29 patients of this group. The arrhythmogenic focus was successfully removed in 79% of cases. Surgical treatment of ventricular tachycardias of various genesis was successful in 76% of cases in follow-up periods of 2 months to 6 years.

Adolescent↗
PubMed1989

[A new method of topical detection of accessory conduction pathways in patients with Wolff-Parkinson-White syndrome].

ECG mapping (90 leads) from the chest surface was used to examine 30 patients with the ventricular preexcitation syndrome. By applying endo- and epicardial mappings, 24, 3, and 1 patients were found to have one, two, and three accessory Kent's bundles, respectively. Two patients with Macheim's tract underwent surface mapping during the maximal preexcitation made via the nodoventricular tract. The authors consider the position of amplitude minimum equal to -0.09 +/- 0.03 mV, on the average, within the first 5 mc from the beginning of QRS complex (0 to 28 mc) to be a criterion for localizing the bundle by the surface mapping. To identify Kent's bundle with certainty by employing a small number of leads, the authors used unconventional (10-20) leads. Electrodes were placed in the x-ray topographoanatomic projection of the atrioventricular sulcus onto the chest.

Action Potentials↗
PubMed1987

[Methods and results of catheter electrodestruction in treating tachyarrhythmias].

Catheter electrodestruction (fulguration) was used in 56 patients with supraventricular and ventricular tachycardias resistant to conservative treatment. Its procedure and results are described. Transvenous electrodestruction of the His bundle and proximal portions of the atrioventricular junction was performed in 40 patients. Complete atrioventricular block and pacemaker implantation were used in 39 patients. In 3 cases with first- or second-degree atrioventricular block, tachycardiac paroxysms were absent in the presence of an antiarrhythmic therapy. In 1 case, tachyarrhythmia recurred after 6 months, so that repeated catheter electrodestruction of the His bundle was required. Radical surgery was performed in 16 patients: electrodestruction of atrial arrhythmogenic zones in 5, that of complementary atrioventricular junctions in 9, and that of left-ventricular arrhythmogenic zones in 2. The results were successful (tachyarrhythmias resistant to conservative treatment disappeared altogether at 6 months to 3.5 years follow-up) in 52 patients.

Adolescent↗
PubMed1986

[Surgical treatment of rhythm disorders with simultaneous correction of heart valve defects].

Twenty-five patients (14 males and 11 females aged 11 to 45 years) with rhythm disorders and valvular defects were operated on. Supraventricular paroxysmal tachycardia was the most common of rhythm disorders occurring in 15 cases, with Ebstein's anomaly in 11, mitral valve incompetence in 2, combined mitral defects in 1 and aortic stenosis in 1 of those. Atrial fibrillation was recorded in 7 patients, with Ebstein's anomaly in 2, mitral stenosis in 2, mitral incompetence in 2 and mitral prolapse in 1 of those. Nodal tachycardia was found in 1 patients with Ebstein's anomaly and in 1 patient with mitral valve incompetence. Left-ventricular tachycardia was diagnosed in a female patient with mitral prolapse. The operations were simultaneous and comprised two steps; they were performed under extracorporeal circulation and drug- and cold-induced cardioplegia, with the elimination (surgical interruption) of accessory conduction pathways or removal of arrhythmogenic areas as the first step, and reconstructive surgery on heart valves as the second step.

Adolescent↗
PubMed1984

[Elimination of drug-resistant supraventricular tachyarrhythmia by transvenous electrodestruction of the atrioventricular junction].

The authors report on the first successful employment of transvenous electrodestruction of the atrio-ventricular junction in patients with supraventricular tachyarrhythmias resistant to the drug and electroimpulse therapy. The procedure of transvenous electrodestruction in six patients consisted in making a discharge of 250-350 J from a stationary R-synchronized defibrillator in the area of the compact atrio-ventricular node or the proximal portion of the His bundle. All patients were implanted R-banning ECS-222 Li. The follow-up period after the operation varied from 2 to 6 months. The patients reported no disturbances in cardiac performance and palpitation over this period.

Adult↗