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Biomedical subjects

G Altamura

Publications and source records attributed to G Altamura.

At least 37 records · Page 2Linked to original sources
PubMed1990

Transcutaneous cardiac pacing for termination of tachyarrhythmias.

Transcutaneous cardiac pacing (TCP) was used for interruption of tachyarrhythmias in 31 patients: 20 with ventricular tachycardia (VT); eight with atrioventricular reentrant tachycardia (AVRT) and three had atrioventricular nodal tachycardia (AVNT). The stimulators used (Pace Aid 50/52) allow pacing at programmable rates (50-160 ppm) and output (10-200 mA at 20-msec pulse duration), when possible overdrive pacing was used. Short bursts of stimuli were delivered with increasing current intensity until interruption of the arrhythmia or to the maximum energy tolerated by the patient. VTs were interrupted in eight of the 20 patients: four of the six (67%) treated by overdrive pacing and four of the 14 (29%) were treated by underdrive pacing. Supraventricular tachycardias (SVT) were terminated in eight of the 11 patients: seven out of eight (88%) AVT, and one out of three AVNT (33%). We observed two cases of arrhythmia worsening: a VT acceleration and induction of ventricular fibrillation in a patient with AVNT. TCP was well tolerated by the majority of the patients. We conclude that TCP is an effective method for interruption of ventricular and supraventricular reentrant tachycardias, but the risk of arrhythmia worsening must be considered.

Cardiac Pacing, Artificial↗
PubMed1990

Emergency cardiac pacing for severe bradycardia.

UNLABELLED: Our study included the treatment of transcutaneous cardiac pacing (TCP) in 32 patients: (A) 19 patients were treated in the emergency area for complete symptomatic AV block before endocavitary pacing; (B) five patients were in asystole following DC shock or out-of-hospital cardiac arrest; and (C) eight patients were affected by bifascicular block undergoing emergency surgery and were treated in order to prevent complete AV block. Two transcutaneous stimulators were used. PaceAid-CRC model 50/52 with 20-msec pulse width; the electrodes were positioned on the V3 ECG position and on the back. RESULTS: in all but two patients, it was possible to obtain stable cardiac capture; in one patient arrived in hospital in asystole after prolonged cardiac arrest and in the other one was affected by complete AV block, TCP was ineffective. In groups A and B, TCP was maintained for a mean time of 15 minutes; in group C, TCP was tested in all patients, but performed in only one patient during surgery. Mean threshold was 81 mA. Stimulation was well tolerated in all but five patients. TCP is a reliable, noninvasive method that offers the possibility to initiate pacing within seconds and can be used by medical staff. In our opinion, it should be considered as the first choice emergency treatment of severe symptomatic bradycardia. In asystole, beneficial effects can be obtained only if TCP is performed early enough after the onset of arrhythmia.

Adult↗
PubMed1989

Treatment of ventricular and supraventricular tachyarrhythmias by transcutaneous cardiac pacing.

The efficacy of noninvasive transcutaneous cardiac pacing (TCP) in the treatment of tachyarrhythmic events was tested in 24 patient: 14 with ventricular tachycardia, seven with supraventricular tachycardia and three with atrial flutter. Six (42.9%) ventricular tachycardias were interrupted: in two of the ten patients on whom underdrive pacing was attempted and in all four cases in which overdrive stimulation was possible. Five of the six supraventricular tachycardias utilizing an atrioventricular bypass tract were interrupted, while the TCP was unsuccessful on the only patient with atrioventricular nodal reentrant tachycardia. TCP failed to interrupt the arrhythmia in the three cases of atrial flutter. No clinically significant untoward effects (in particular tachycardia acceleration or ventricular fibrillation) were observed, except for a tolerable thumping sensation on the chest during pacing. In four patients, TCP effects on cardiac activation was evaluated by endocavitary recording: while the mean ventricular threshold was 70 mA, atrial capture was possible on only two patients at a current intensity of 140 and 150 mA. We consider our preliminary experience with TCP in the treatment of tachycardias encouraging. The technique was easily and rapidly usable and it was immediately successful in the majority of atrioventricular reentrant tachycardias and in a relevant percentage of ventricular tachycardias. In this latter setting TCP was mostly effective in the slower tachycardias where overdrive pacing was possible. A further experience with devices provided by higher pacing rates is warranted.

Cardiac Pacing, Artificial↗
PubMed1986

[Transvenous cardioversion in the treatment of sustained ventricular tachycardia. Preliminary results in 3 patients with implantable cardioverter].

The efficacy of intracardiac cardioversion was verified in 11 pts suffering from coronary heart disease and recurrent sustained VT. All pts were receiving anti-arrhythmic drugs. Tachycardia cycle length was between 280 and 400 msec. 65 episodes of VT (21 spontaneous and 44 induced) were treated with synchronized shocks of low energy between 0.27 and 2 J using the external cardioverter. Cardioversion was successful in 83% of VT episodes. VT acceleration occurred in one case; transient atrial fibrillation was induced six times. All pts tolerated shocks from 0.27 to 1 J with moderate discomfort; shocks exceeding 1.0 J were less well tolerated. CK levels were not increased. In three pts (VT cycle length of 320, 380 and 400 msec) a permanent Cardioverter (Medtronic Model 7210) was implanted and programmed to operate in non-automatic mode. Every month the pts underwent a follow-up visit to verify the electrophysiological features of VT in non invasively induced VT episodes and the efficacy of transvenous cardioversion. In a mean follow-up period of 9 months, respectively 5, 4 and 3 spontaneous VT episodes occurred. In two pts cardioversion resulted constantly effective, whereas in the third one provoked VT acceleration requiring DC-shock in the last spontaneous episode of VT.

Aged↗
PubMed1983

[Malignant ventricular hyperkinetic arrhythmia: role of permanent electric treatment].

While the technics of cardiac pacing have shown to have a precise role in the diagnosis and treatment of ventricular arrhythmias on a temporary basis, the role of permanent antiarrhythmic devices (PAD) in the treatment of these arrhythmias is still ill defined mainly because of the technological limits concerning the pacemakers and the frequent complications observed during the attempts to interrupt such tachycardias. On the basis of the available data and of theoretical considerations, three groups of pts susceptible of treatment with PAD can be selected: a) pts with brady-dependent arrhythmias where PAD is used as a prophylactic mean; b) pts with recurrent sustained ventricular tachycardia refractory to medical treatment, in whom PAD can be used to interrupt tachycardia; c) pts affected by ventricular fibrillation or rapidly deteriorating ventricular tachycardia (sudden death pts), refractory to conventional treatment, in whom the implantable defibrillator represents the only therapeutic possibility. Even if scanty, the data available seem to confirm that PAD does have a role in the treatment of malignant arrhythmias, although in selected cases and almost always together with drug treatment.

Arrhythmias, Cardiac↗
PubMed1981

[Physiopathologic mechanism of ventricular fibrillation induced by atropine. Report of two cases (author's transl)].

The authors report on two cases of ventricular fibrillation induced by bolus of atropine injected for diagnostic purpose. The electrophysiologic effect of adrenergic stimulation following the parasympathetic blockade, is probably the responsible mechanism rather than myocardial ischemia in the first patient, affected by complete a-v block with narrow QRS. The second patient, affected by coronary heart disease and suspected sick sinus syndrome, had more probably a ventricular fibrillation because of a worsening of the underlying myocardial ischemia due to the increase of the cardiac rate. the reported observations, together with those of other Authors, suggest that atropine, at least when used for diagnostic purpose, should be employed cautiously and preferably having available all the equipment for emergency treatment of cardiorespiratory arrest.

Aged↗
PubMed1980

[Atrial demand pacemaker and radio-frequency system in the treatment of brady-tachy syndrome and of recurrent supraventricular tachycardia refractory to drug therapy. Methods and results in eight cases (author's transl)].

The Authors refer on the methods and the results of permanent electrical treatment with atrial demand pacemakers and radio-frequency systems in 6 cases of brady-tachy syndrome and in 2 cases of recurrent supraventricular tachycardia refractory to drug therapy. In the 6 patients with brady-tachy syndrome atrial demand pacemakers with incorporated radiofrequency receiver were employed; in the 2 patients with supraventricular tachycardia a subcutaneous receiver for radiofrequency stimulation was implanted. The catheters employed were: in 3 patients screw-in leads placed in the right atrial appendage and in 5 unipolar sinus coronary leads. The patient-activated transmitter is been realized in two models: the first one can emit short bursts of eight impulses at the rates of 150-220-260 b/m, each one is selectable by the patient; the number and the period of the beats of the second transmitter can be programmed only by one of us; the stimulator is then given to the patient with a personalized fixed program accordingly to the electrophysiological and clinical observations. During a mean follow up of 7.7 months the safety of the leads both for the stability and the electrical behaviour was noticed in all patients but one with a coronary sinus lead in which a stimulation failure was noticed after the eighth month of stimulation because of high threshold requiring the implantation of a ventricular pacemaker. In the brady-tachy syndrome cases the treatment had a considerable antiarrhythmic efficacy, each patient showing a reduction of hyperkinetic episodes and the ability to interrupt them. In the two cases of refractory supraventricular tachycardia a complete control of the episodes by overdrive stimulation was obtained.

Aged↗
PubMed1978

[The criteria for the choice of a cardiac pacemaker (author's transl)].

The criteria commonly followed for the choice of a cardiac pacemaker to be used in the treatment of AV blocks and sick sinus syndrome are described. In case of AV block, the AA, believe that at first implant a ventricular inhibited pacemaker is to be preferred, while for the replacements the choice will be based on clinical grounds (mainly from the data obtained during the periodic controls, such as persistence of spontaneous activity, failure of sensing, etc.). In case of sick sinus syndrome, ventricular inhibited pacemakers are generally to be preferred firstly to secure stimulation even in case of AV block, secondly for the advantage of a greater stability of the endoventricular catheter. Atrial pacemakers (asynchronous, on demand, or bifocal) will be preferred when the atrial contribution is believed to be important from an haemodynamic point of view. Lastly, in single cases, its is possible to implant radiofrequency devices connected with the electrocatheter for the control of the tachyarrhythmic phases.

Cardiac Pacing, Artificial↗