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Biomedical subjects

G M Gribbin

Publications and source records attributed to G M Gribbin.

6 recordsLinked to original sources
PubMed1999

Effect of pacing mode on morbidity and mortality: update of clinical pacing trials.

Retrospective studies have suggested that, in patients with sick sinus syndrome, it has been recognized that atrial, dual-chamber, or other so-called physiologic modes of pacing are associated with a lower incidence of atrial fibrillation, stroke, heart failure, and death than is single-chamber ventricular pacing. Retrospective data in patients with atrioventricular block are less robust, but still suggest lower mortality and morbidity with dual-chamber pacing compared with ventricular pacing alone. Overall, the reduction in risk of atrial fibrillation with dual-chamber compared with ventricular pacing has been calculated at 62%, and for death 36%. Retrospective studies are, of course, potentially subject to bias, and there may be a tendency to implant cheaper, simpler pacemakers in older, sicker patients, which could explain the apparent difference in outcome. Prospective studies are, therefore, required; results from 3 such studies, in which pacing mode was randomly allocated, have been recently published. These, in general, support the apparent benefit of dual-chamber pacing in patients with sick sinus syndrome, but give equivocal results in patients with heart block. Other trials are in progress, and their results are awaited. Like all good trials, they will, in addition to providing some answers, generate further questions. They should provide the evidence on which cost-effective pacing policies may be based.

Cause of Death↗
PubMed1999

Chronic atrial fibrillation in patients with paroxysmal atrial fibrillation, atrioventricular node ablation and pacemakers: determinants and treatment.

AIMS: This study examined the factors associated with the development of chronic (or permanent) atrial fibrillation (AF) in patients who had undergone atrioventricular (AV) node ablation with permanent pacing because of paroxysmal AF. METHODS: A retrospective review of case notes of all 65 consecutive patients identified as having had paroxysmal atrial arrhythmias, AV node ablation and permanent pacemaker implantation was performed. Atrial rhythm was established from all pacing records and from the surface ECG. Treatment with anti-arrhythmic drugs and with warfarin was recorded. A multivariate analysis was undertaken, using atrial rhythm on final ECG and chronic AF as outcome measures. RESULTS: During a mean follow-up of 30 months, 42% of patients with paroxysmal AF had developed chronic AF. Multivariate analysis showed that increasing age, history of electrical cardioversion and VVI pacing all contributed to the development of chronic AF. 25/62 patients were taking warfarin, and four had had strokes (2.5%/year). CONCLUSION: The majority of patients with paroxysmal atrial arrhythmias treated with AV node ablation and pacing develop chronic AF eventually. Stroke remains a risk, particularly in those who develop chronic AF.

Anticoagulants↗
PubMed1998

Predictors of atrial rhythm after atrioventricular node ablation for the treatment of paroxysmal atrial arrhythmias.

OBJECTIVE: To assess the natural history of the atrial rhythm of patients with paroxysmal atrial arrhythmias undergoing atrioventricular node ablation and permanent pacemaker implantation. DESIGN AND SETTING: A retrospective cohort study of consecutive patients identified from the pacemaker database and electrophysiology records of a tertiary referral hospital. PATIENTS: 62 consecutive patients with paroxysmal atrial arrhythmias undergoing atrioventricular node ablation and permanent pacemaker implantation between 1988 and July 1996. MAIN OUTCOME MEASURES: (1) Atrial rhythm on final follow up ECG, classified as either ordered (sinus rhythm or atrial pacing) or disordered (atrial fibrillation, atrial flutter or atrial tachycardia). (2) Chronic atrial fibrillation, defined as a disordered rhythm on two consecutive ECGs (or throughout a 24 hour Holter recording) with no ordered rhythm subsequently documented. RESULTS: Survival analysis showed that 75% of patients progressed to chronic atrial fibrillation by 2584 days (86 months). On multiple logistic regression analysis a history of electrical cardioversion, increasing patient age, and VVI pacing were associated with the development of chronic atrial fibrillation. A history of electrical cardioversion and increasing patient age were associated with a disordered atrial rhythm on the final follow up ECG. CONCLUSIONS: Patients with paroxysmal atrial arrhythmias are at high risk of developing chronic atrial fibrillation. A history of direct current cardioversion.

Age Factors↗