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Biomedical subjects

I W Obel

Publications and source records attributed to I W Obel.

12 recordsLinked to original sources
PubMed1990

Efficacy of oral sotalol in reentrant ventricular tachycardia.

Oral sotalol was given to 64 patients (78% postinfarction) with recurrent, reentrant ventricular tachycardia (VT) during an average follow-up period of 19.7 months. Fifty-nine (92%) patients had previously experienced recurrent ventricular tachycardia, in spite of having received an average of three conventional antiarrhythmic drugs (13 had previously failed on other Class III drugs). The nature and mechanism of the VT was proved with electrophysiologic testing (EPS), and the chronic sotalol dosage was determined by repeated EPS at 3- to 4-day intervals until the VT was no longer inducible. Sotalol failed in five patients and was discontinued in six patients because of severe side effects (three proarrhythmic effects, including two with torsades de pointes)--a total of 18%. Sotalol was successful alone in 42 patients (65%) and in combination with another antiarrhythmic drug in 11 patients (18%). The average dose of sotalol required for success was 589 mg; 658 mg was the mean daily dose when given alone and 486 mg when given in combination. Side effects were common and were due mainly to the beta-blocking effects of sotalol. Dual chamber pacing was required by 11 patients because of poorly tolerated bradycardia, and 14 patients remained symptomatic from worsening of the cardiac failure in spite of pacing, increased diuretics, or vasodilator therapy. The average drug dosage was the same for symptomatic (680 mg) and asymptomatic (627 mg) patients. Sotalol is a valuable antiarrhythmic drug for reentrant ventricular tachycardia. High doses are needed, and at these doses the beta-blocking activity is responsible for most of the side effects.

Administration, Oral↗
PubMed1989

Atrial pacing and the risk for AV block: is there a time for change in attitude?

A literature survey was performed to establish the prevalence of second and third degree AV block among patients with permanent atrial pacemakers because of sinus node disease. This study reviews data from 28 different studies on atrial pacing with a median follow-up of 36 months. The collected data shows a median annual incidence of second and third degree AV block of 0.6%, range 0%-4.5% with a total prevalence of 2.1%, range 0%-11.9%. There was no significant difference in follow-up time between studies that showed a low, compared with a high incidence of AV-block. Patients with sinus node disease treated with atrial pacing have a low risk of developing clinically important conduction disturbances.

Arrhythmia, Sinus↗
PubMed1978

Clinical and electrophysiological observations with disopyramide in drug-resistant and recurrent symptomatic arrhythmias.

Seventeen patients with recurrent symptomatic arrhythmias were treated with oral disopyramide (DP). Fifteen of the 17 patients had received other currently conventional anti-arrhythmic therapy, to which only 1 patient responded, yet 13 of these 15 patients with resistant arrhythmias responded to DP. Electrophysiological studies were performed on 9 patients. The most impressive electrophysiological findings were the depressant effect of DP on ventricular automaticity and its action in slowing conduction through the His-Purkinje system (including the bundle branches) without depressing sino-atrial rate and atrioventricular (AV) nodal conduction time. Retrograde ventriculo-atrial (VA) conduction was markedly prolonged in 4 patients with reciprocating supraventricular tachycardia (SVT), including 2 patients with Wolff-Parkinson-White syndrome. All 4 patients with reciprocating SVT appear to be cured of their arrhythmia, probably by this mechanism.

Adult↗
PubMed1978

Prolonged circulatory support with the intra-aortic balloon pump after myocardial infarction.

Circulation was supported by intra-aortic balloon counterpulsation for 30 and 38 days respectively in two patients with cardiogenic shock after acute myocardial infarction. One was flown 1400 km to Cape Town for heart transplantation but died after being weaned from the pump while awaiting a suitable donor. The other underwent successful surgical closure of a ruptured ventricular septum on the 30th day, allowing time for the edges of the ventricular septal defect to fibrose. Neither significant damage to circulating blood elements nor infection occurred, confirming the feasibility of prolonged circulatory support.

Acute Disease↗
PubMed1976

Haemodynamics and treatment of right ventricular infarction.

In this article 2 cases of myocardial infarction with haemodynamically dominant right ventricular infarction are reported. The incidence and significance of the condition are discussed. The use of haemodynamic monitoring in diagnosis and management is stressed and the response to fluid therapy, either alone or together with inotropic drugs, is discussed.

Aged↗
PubMed1976

Acute myocardial infarction with normal coronary arteries: a possible manifestation of the billowing mitral leaflet syndrome.

The findings in four young patients with the billowing mitral leaflet syndrome who presented with evidence of acute myocardial infarction are reported. Because technically adequate coronary arteriograms demonstrated patent vessels and the electrocardiograms initially showed pronounced elevation of the ST segments as occurs in Prinzmetal's angina, it is postulated that spasm of normal coronary arteries was the operative factor. Scrutiny of those cases of clinically apparent ischemic heart disease with normal coronary angiograms is suggested to establish whether there is in fact a causal relationship with the billowing mitral leaflet syndrome.

Adult↗