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Biomedical subjects

B J Deal

Publications and source records attributed to B J Deal.

33 records · Page 2Linked to original sources
PubMed1992

Supraventricular tachycardia mechanisms and their age distribution in pediatric patients.

To better define the natural history of supraventricular tachycardia (SVT) in young patients, age distribution of SVT mechanisms was examined in 137 infants, children and adolescents. Patients with a history of cardiac surgery or neuromuscular diseases were excluded. An electrophysiologic study was performed in each patient: transesophageal (110 patients) or transvenous (14 patients) or both (13 patients). Mechanisms were classified as SVT using accessory atrioventricular (AV) connection (SVT using accessory connection, including orthodromic and antidromic reciprocating tachycardia), primary atrial tachycardia (including chaotic, automatic and reentrant atrial tachycardia), and tachycardia due to reentry within the AV node. SVT using accessory connection occurred in 100 of 137 patients (73%) and was the most prevalent mechanism. Primary atrial tachycardia and reentry within the AV node were present in 19 of 137 (14%) and 18 of 137 (13%) patients, respectively. Using a multinomial logit model, relative probabilities for tachycardia mechanisms for 5 age groups--prenatal, less than 1, 1 to 5, 6 to 10 and greater than 10 years--were determined. Primary atrial tachycardia (11 to 16%) and SVT using accessory connection (58 to 84%) appeared throughout infancy, childhood and adolescence. On the other hand, tachycardia due to reentry within the AV node (0 to 31%) rarely appeared before age 2 years. Mechanisms of SVT appear to have age-dependent distributions. SVT using accessory connection is the most common mechanism in young patients. We speculate that the propensity to tachycardia due to reentry within the AV node occurs during postnatal development.

Adolescent↗
PubMed1991

Use of amiodarone for short-term and adjuvant therapy in young patients.

Limited data are available defining the safety of amiodarone for short-term use or as part of combination antiarrhythmic therapy in pediatric patients. Results of amiodarone in 47 young patients for an average treatment duration of 12 months were examined. There were 21 male and 26 female patients (age range of 23 weeks gestation to 29 years). Patients were divided into 4 groups: group 1--electrocardiographic documented ventricular tachycardia (n = 7); group 2--syncope of unknown cause (n = 16); group 3--primary atrial tachycardia (n = 11); and group 4--supraventricular tachycardia (n = 13). Amiodarone was clinically useful in 32 (68%) patients. Amiodarone was considered effective as a sole antiarrhythmic agent in 21 (45%) patients. Treatment was ineffective but was continued in 11 (23%) patients; in 10 of these 11 patients amiodarone was adjuvant to other antiarrhythmic drugs. Amiodarone was considered ineffective and was withdrawn in 15 (32%) patients. No patient required cardiac pacemaker implant during therapy. Torsades de pointes and cardiac arrest occurred in 1 patient each after 9 and 14 days of therapy, respectively. Two patients underwent successful cardiac transplant after 2 and 14 months of amiodarone administration, respectively. Amiodarone was used as short-term treatment (less than 18 months) in 7 infants (age less than 18 months), and after cessation of treatment there was no recurrence of tachycardia for 4 to 24 months. Results of this study confirm reports of successful amiodarone use in pediatric patients with a variety of rhythm disturbances.(ABSTRACT TRUNCATED AT 250 WORDS)

Administration, Oral↗
PubMed1991

Program planning for the certified emergency nursing review course.

Preparation for the CEN Review Course is time-consuming, but when the above steps are followed, it will prove successful and rewarding for both the sponsors and participants. As members of a professional association and coordinators of an education offering, a vital role as a CE provider can be filled. It is through the efforts of those planning the course that the ENA and its members are able to meet the CE needs of nurses.

Budgets↗
PubMed1990

Ventricular arrhythmias in postoperative tetralogy of Fallot.

Ventricular arrhythmias in patients after total surgical repair of tetralogy of Fallot have been associated with late sudden death. In this large multicenter retrospective study of 359 patients with postoperative tetralogy of Fallot, spontaneous ventricular premature complexes (VPCs) on 24-hour ambulatory electrocardiographic monitoring and laboratory-induced ventricular tachycardia (VT) by electrophysiologic stimulation were analyzed. The mean age at surgical repair was 5 years and the mean follow-up duration after repair was 7 years. Spontaneous VPCs on ambulatory monitoring were found in 48% and induced VT on electrophysiologic stimulation was found in 17% of patients. Both spontaneous VPCs and induced VT were significantly related to delayed age at repair, longer follow-up interval, symptoms of syncope or presyncope and right ventricular systolic hypertension (greater than 60 mm Hg) (p less than 0.05), but not to right ventricular diastolic pressure greater than 8 mm Hg. The VPCs on ambulatory monitoring were more complex with increasing age at repair and follow-up duration. Induction of VT on electrophysiologic stimulation correlated with spontaneous VPCs including VT on 24-hour ambulatory electrocardiographic monitoring. The electrophysiologic stimulation protocol varied and the induction of VT increased with a more aggressive stimulation protocol. While induced sustained monomorphic VT was related to all forms of spontaneous VPCs, induced nonsustained polymorphic VT was related to more complex forms of VPCs on ambulatory monitoring. VT was not induced in asymptomatic patients who had normal 24-hour ambulatory electrocardiographic monitoring and normal right ventricular systolic pressure. (ABSTRACT TRUNCATED AT 250 WORDS)

Age Factors↗
PubMed1987

Electrophysiologic drug testing in symptomatic ventricular arrhythmias after repair of tetralogy of Fallot.

Nine patients with symptomatic ventricular arrhythmias were evaluated a mean interval of 16 years after surgical repair of tetralogy of Fallot. The clinical arrhythmia was sustained ventricular tachycardia (VT) in 4 patients (group I) and premature ventricular contractions in 5 (group II). All patients underwent cardiac catheterization and electrophysiologic studies. Ventricular tachycardia was induced at electrophysiologic study in all patients in group I and in 3 patients in group II. Six patients with inducible sustained monomorphic VT underwent chronic drug testing based on electrophysiologic study. A mean of 3.3 drugs per patient was tested. Patients with right ventricular systolic hypertension did not respond to any drug tested, and underwent surgery. Five patients received drug treatment based on the results of electrophysiologic study. During a mean follow-up period of 2.2 years, no patient in either group had recurrent episodes of VT or syncope. In the postoperative patient with tetralogy of Fallot with symptomatic ventricular arrhythmias, it is concluded that electrophysiologic study is useful in reproducing clinical episodes of VT and in selecting effective antiarrhythmic medication; a small number of patients with ventricular premature complexes alone will have inducible sustained VT during electrophysiologic study; prognosis of these patients may be improved by treatment that results in prevention of VT induction; and in patients with right ventricular hypertension, VT is likely to be refractory to drug treatment.

Adolescent↗
PubMed1986

Congenital aneurysm of the left sinus of Valsalva with an aortopulmonary tunnel.

Aneurysm of the left sinus of Valsalva is rare, and there is only one previous report of rupture into the pulmonary artery. This report describes a patient with valvular pulmonary atresia and ventricular septal defect in whom a portion of his pulmonary blood flow was supplied by an aortopulmonary tunnel arising from a left sinus of Valsalva aneurysm. The surgical implications of precise definition of the type of aortopulmonary communication are discussed.

Aorta↗
PubMed1986

Ventricular tachycardia in a young population without overt heart disease.

Since 1974, 24 young patients presenting with ventricular tachycardia and without clinical evidence of heart disease were evaluated and followed. Sixteen patients (67%) were symptomatic. Clinical episodes of ventricular tachycardia were sustained in 18, incessant in four, and nonsustained in two patients. The rate of tachycardia ranged from 130 to 300 beats/min (mean = 200 beats/min). Subtle abnormalities of cardiac size or function were present at cardiac catheterization in 16 of 23 patients (70%). During electrophysiologic studies, spontaneous ventricular tachycardia was present in six patients. The clinical ventricular tachycardia was inducible by programmed stimulation in 13 of 18 patients. The site of origin of tachycardia based on endocardial mapping in 17 patients was the right ventricle in 14, the ventricular septum in one, and indeterminate in two patients. Seventeen patients were treated based on results of short-term drug testing. During a mean follow-up period of 7.5 years, three patients died suddenly; none of these patients were receiving antiarrhythmic medication at the time of death. We conclude that in a young population without clinical evidence of heart disease, ventricular tachycardia may be the first manifestation of cardiomyopathy, since at least two-thirds of these patients have abnormalities at cardiac catheterization. Without treatment mortality in this population may be as high as 13% over an 8 year period. Presently we recommend treatment of ventricular tachycardia in any symptomatic patient, with therapy guided by electrophysiologic and treadmill testing. In addition, we recommend treatment for any asymptomatic patient with exercise-related tachycardia, since this group appears to be at increased risk for sudden death.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1986

Arrhythmias in the tiny, premature infant.

In contrast to the older infant or child in whom arrhythmias are usually secondary to congenital heart disease, arrhythmias in the small, preterm infant are most commonly secondary to central nervous system immaturity or extrinsic causes. Bradycardia is the most common arrhythmia observed in this population. The staff involved in the care of these extremely fragile and usually complicated patients have to be aware of the possibility of other rhythm disturbances occurring in such patients; this will help recognition and appropriate management of the individual cases.

Arrhythmias, Cardiac↗
PubMed1985

Subxiphoid two-dimensional echocardiographic identification of tricuspid valve abnormalities in transposition of the great arteries with ventricular septal defect.

Tricuspid valve morphology was examined using subxiphoid 2-dimensional echocardiography (2-D echo) in 39 infants aged 2 years or younger who had transposition of the great arteries (TGA) and ventricular septal defect (VSD) (group I). Age-matched control groups were 21 patients with simple TGA (group II), 30 patients with VSD and normally related great arteries (group III), and 15 normal patients (group IV). Valve abnormalities, consisting of chordal attachments to the infundibular septum or ventricular septal crest, straddling, overriding or some combination of these, were identified in 25 of 39 patients (64%) in group I, no patients in groups II or IV and 6 of 30 patients (20%) in group III. Intraatrial baffle repair was performed in 27 patients in group I (median age at surgery 3.5 months) and 19 patients in group II (median age 4 months). Preoperative right ventricular angiography, performed in all patients with TGA, demonstrated tricuspid regurgitation (TR) with biventricular dysfunction in 1 patient in group I. After surgery, TR was present in 9 of 17 group I patients and none of the 8 group II patients who underwent catheterization. All patients in whom TR was not present preoperatively had abnormal chordal attachments; 3 required valve replacement. These results demonstrate that tricuspid valve abnormalities are common in patients with TGA and VSD and may be identified preoperatively using 2-D echo. Patients with abnormal chordal attachments are at increased risk for TR after intraatrial baffle repair and should be considered for arterial switch repair.

Cardiac Catheterization↗
PubMed1985

Wolff-Parkinson-White syndrome and supraventricular tachycardia during infancy: management and follow-up.

The records of 90 patients with Wolff-Parkinson-White syndrome who presented with supraventricular tachycardia in the first 4 months of life were reviewed. Among these, 63% were male. Structural heart disease was present in 20%, most commonly Ebstein's anomaly. All patients presented with a regular narrow QRS tachycardia, and pre-excitation became evident only when normal sinus rhythm was established. Only one infant had atrial flutter and none had atrial fibrillation. Type A Wolff-Parkinson-White syndrome was most common (49%), with heart disease occurring in only 5% of these patients. In contrast, heart disease was identified in 45% of those with type B syndrome. Initially, normal sinus rhythm was achieved in 88% of the 66 infants treated with digoxin with no deaths. Normal sinus rhythm resumed after electrical countershock in 87% of the 15 infants so treated. Maintenance digoxin therapy was used in 85 patients. The Wolff-Parkinson-White pattern disappeared in 36% of the patients. Four infants died of cardiac causes during the mean follow-up period of 6.5 years. Two of these four infants had congenital heart disease; the third, with a normal heart initially, developed ventricular fibrillation and died from a cardiomyopathy considered related to resuscitation. The remaining infant, with a normal heart, died suddenly at 1 month of age. All were receiving digoxin. A wide QRS tachycardia later appeared in three patients, all with heart disease, one of whom died.(ABSTRACT TRUNCATED AT 250 WORDS)

Combined Modality Therapy↗
PubMedDate not supplied

New directions in surgical therapy of arrhythmias.

The success of the radiofrequency catheter ablation procedure for most types of supraventricular and ventricular tachycardia, particularly in young patients, largely eliminated the role of surgical therapy of arrhythmias. However, there remains a subset of arrhythmia patients in whom the catheter approach has not been successful and types of arrhythmias with high recurrence rates following initially successful catheter ablation procedures where surgery can provide more definitive therapy. In addition, the concepts of ablation therapy can be successfully incorporated into the concomitant repair of complex congenital heart disease, resulting in single-stage therapy for structural and rhythm abnormalities. Prospectively, knowledge of the role of anatomic barriers as substrates for future reentrant arrhythmia circuits provides the opportunity to alter these circuits prophylactically at the time of initial surgical repair of congenital heart disease in an attempt to avoid the late development of tachycardia. This article describes our experience during the past decade with 71 patients undergoing arrhythmia surgery using this approach.

Arrhythmias, Cardiac↗
PubMedDate not supplied

A comparison of steroid-eluting epicardial versus transvenous pacing leads in children.

OBJECTIVE: To evaluate the acute and chronic performance of steroid-eluting (SE) epicardial (EPI) pacing leads as compared to SE transvenous (TV) pacing leads in children. METHODS: From 1989 through 1997, 55 children with congenital heart disease received a total of 85 SE pacing leads, of which 38 were EPI and 47 TV. The mean age of children receiving EPI leads was younger than those receiving TV leads (7.7 months vs 15.1 years, p = 0.001), and they had shorter follow-up (17.2 months vs 36.2 months, p < 0.001). All leads were evaluated for acute and chronic sensing and capture thresholds, and impedance. RESULTS: Acute and in particular chronic atrial and ventricular sensing and capture thresholds in SE EPI and TV leads were essentially equivalent. [table: see text]. The chronic impedance of TV leads (atrial 525 ohms, ventricular 520 ohms) was consistently higher than EPI leads (atrial 404 ohms, ventricular 386 ohms). CONCLUSION: At intermediate follow-up, SE EPI leads are functionally equivalent to SE TV leads. We recommend the use of SE EPI leads as long as practically feasible prior to using the TV approach in children who will require a life-time of pacing.

Adolescent↗