Biomedical subjects
Publications and source records attributed to E D Rimsha.
The analysis of the data available in the literature has shown that bipolar pacing systems are promising. The paper indicates that the first samples of a Soviet bipolar electrode have been made and tested in the laboratory setting. It also raises whether it is necessary to design bipolar pacemakers.
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The results of ventricular, atrial and sequential atrioventricular pacing, conducted in 16 cases of open-heart surgery, demonstrated that sequential atrioventricular pacing produced the best hemodynamic effect owing to the optimization of atrioventricular delay and impulse frequency.
Medical and occupational rehabilitation following pacemaker implantation is discussed with special reference to objective quality of medical and technical data, on which occupational recommendations are to be based. A comprehensive analysis of whether an individual with an implanted pacemaker can drive a car is presented.
A noninvasive method of electrophysiologic investigation (EPI) making use of programmed esophageal electrostimulation of the heart has been developed on the basis of EPI carried out in 2158 inpatients (including 1273 procedures involving esophageal electrostimulation of the heart). Its introduction in an outpatient cardiologic clinic in Kaunas made it possible to investigate 522 patients with heart rhythm disorders in 1985 alone. Effective antiarrhythmic therapy could be selected for 389 (74.5%) patients on an outpatient basis, while 133 (25.5%) patients had to be referred to hospital for more detailed EPI, implantation of an indwelling pacemaker or radical surgery. It is demonstrated that an adequate antiarrhythmic treatment can be selected on an outpatient basis.
Thirty-three children, aged 6 months to 14 years, with the pre-excitation syndrome were examined. Esophageal electrophysiological heart studies were conducted in all cases, and intracardiac electrophysiological studies, in 11 of those. Functional characteristics of the accessory pathways were established, and the most efficient treatment chosen. Nine children were in need of surgical treatment because of the short effective refractory period of the accessory pathways and life-threatening arrhythmias. Radical operations (surgical interruption of the accessory pathways) were performed in 22 children.
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Possibilities of improving the efficacy of the trans-esophageal ventricular electrostimulation were studied in 22 patients with pacemaker weakness, the Wolff-Parkinson-White syndrome, transverse block and other disorders of the rhythm and conductivity of the heart. It has been shown that the amplitude of impulses in trans-esophageal ventricular electrostimulation may be decreased on the average to 32.36 +/- 1.37 V with the help of a specially-designed electrode, the optimal positioning of its cathode contact in the esophagus and the lengthening of electrical impulses. Trans-esophageal electrostimulation of the ventricles broadens the possibilities of the noninvasive electrophysiological examination and the treatment of complicated disturbances of the cardiac rhythm and conductivity.
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Re-entry tachycardia was found in 182 patients of a total of 275 subjected to electrophysiological investigation of heart function; in 26 of those, a radio-frequency atrial electrostimulation system was implanted. Early postoperative complications were noted in 3 patients: subcutaneous hematoma in 2, and skin decubitus in 1. Long-term follow-up (as long as 7 years) confirmed the efficiency of atrial radio-frequency pacing.
Patterns of dp/tdmax, left-ventricular volumes and expulsion fraction were examined with the aid of single ventriculography during pacemaker operation and after the device was switched off in 33 patients, divided into 5 groups on the basis of severity of arterial and myocardial lesions. Final systolic volume only changed significantly in patients with sharp coronary arterial changes (group 4). Final diastolic volume increased by 20-27%, and the expulsion fraction, by 7-24%, at post-stimulation potentiation in all the groups. Patterns of dp/tdmax showed differences among the groups. Comparison of dp/dtmax with final diastolic volume revealed a more distinct difference between the groups depending on the severity of changes in myocardial contractility and functional reserves. Compared to other exercise tests this method is more sensitive, convenient and safe for patients with severe heart rate disorders and massive myocardial lesions.
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The procedures involved in different techniques of cardiac electrostimulation for the diagnosis of the pre-excitement syndrome were examined in 154 patients. In a group of 150 patients with provoked (140) or spontaneous (10) tachycardia developing in response to endocardial electrocartography, the paroxysmal supraventricular tachycardia was noted in 95.5%, atrial flutter in 11.4%, atrial flutter-fibrillation in 5.7%, atrial fibrillation in 29.8%, A-V tachycardia in 3.7%. The methods of diagnostic cardiac electrostimulation are of great importance in determining the type, localization, electrophysiologic properties and mechanisms of heart rhythm disorders and in selecting a rational therapeutic method.
The authors describe the technique and the results of the operation of the dextra-located Kent's bundle in patients with the Wolff - Parkinson - White syndrome. In all 10 patients the interruption of the pathological conductivity was successful (1 patient was operated on again). In the left-sided localization in 8 out of 11 patients the stimulation syndrome was removed permanently, in 2 temporarily and in 1 the operation was unsuccessful. In 1 patient radio-frequency cardiostimulator has been grafted to stop the attacks.