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Biomedical subjects

J Federman

Publications and source records attributed to J Federman.

At least 37 records · Page 2Linked to original sources
PubMed1985

Control of refractory supraventricular arrhythmias after unsuccessful closed-chest His bundle ablation.

Six patients underwent attempted catheter ablation of the His bundle for control of refractory supraventricular tachyarrhythmias. Permanent complete heart block was achieved in only three patients. All six patients have remained asymptomatic without antiarrhythmic medications over a follow-up period of six to 17 months (mean 10 months). There were no complications of the procedure apart from mild elevation of creatine kinase levels in three patients. In this series, resumption of atrioventricular (AV) conduction following attempted His bundle ablation was not associated with recurrence of symptomatic arrhythmias. Preservation of AV conduction may also obviate the need for permanent ventricular pacing.

Adult↗
PubMed1984

Oral beta-adrenergic blockade with metoprolol in chronic severe dilated cardiomyopathy.

A double-blind crossover trial was performed to assess the effect of metoprolol in 10 patients (mean age 55 years) with severe dilated cardiomyopathy. All patients clinically had idiopathic dilated cardiomyopathy; however, at coronary angiography, four had occult coronary disease. All were in New York Heart Association functional class III with a left ventricular ejection fraction less than 35% as assessed by rest radionuclide ventriculography. Studies were performed before treatment, after 4 weeks of metoprolol therapy and after 4 weeks of placebo administration. Erect bicycle sprint exercise was used to determine maximal work load. Hemodynamic variables and radionuclide left ventricular ejection fraction were recorded at rest and during graded supine bicycle exercise. Cardiac medications were unchanged throughout the trial. The mean (+/- standard error of the mean) dose of metoprolol was 130 +/- 13 mg/day. Metoprolol did not change symptoms, chest X-ray findings or exercise tolerance (baseline 700 +/- 73, placebo 690 +/- 85, metoprolol 710 +/- 81 kilopond-meters [kpm]/min). Metoprolol produced a significant decrease in heart rate at rest and during exercise (p less than 0.001). Mean blood pressure and left ventricular filling pressure did not differ significantly in the baseline, placebo and metoprolol studies. There was a slight, but significant (p less than 0.05) decrease in cardiac index with metoprolol compared with placebo and baseline studies. The small, but significant increase in left ventricular ejection fraction from baseline to the metoprolol and placebo studies (p less than 0.001) was considered a result of spontaneous improvement rather than of therapy. No significant differences were found between the patients with and without coronary disease.(ABSTRACT TRUNCATED AT 250 WORDS)

Administration, Oral↗
PubMed1984

Acute intravenous and sustained oral treatment with the beta1 agonist prenalterol in patients with chronic severe cardiac failure.

Prenalterol, a beta1 agonist, was given in a single blind acute intravenous study to seven patients with cardiac failure (New York Heart Association class II and III). It was then given in a double blind crossover study of sustained oral prenalterol to six of them. As a result of dose titration studies the oral dose of prenalterol given was 100 mg twice a day in all patients. Erect bicycle sprint tests were performed to exercise tolerance before and after treatment had been started. Cardiac function was assessed at rest and during graded supine bicycle exercise by determining haemodynamic indices using a Swan-Ganz catheter and radionuclide left ventricular ejection fractions. In the intravenous study cardiac function was assessed at rest and during exercise after a control infusion of dextrose and after an infusion of 5 mg prenalterol. In the oral crossover study a placebo or prenalterol were given for two periods of two weeks; at the end of each period exercise tolerance was measured and cardiac function assessed at rest and during exercise. Throughout the study period there was no change in symptoms, medication, or exercise tolerance. Intravenous prenalterol significantly improved cardiac function; left ventricular ejection fraction and cardiac index increased and left ventricular filling pressure fell both at rest and during exercise. Sustained oral treatment with prenalterol, however, did not improve resting left ventricular filling pressure or left ventricular ejection fraction at rest or during exercise but did increase heart rate at rest, and mean blood pressure and peripheral vascular resistance at rest and during exercise; in fact, during exercise left ventricular filling pressure was significantly increased while cardiac index and stroke volume index were decreased by prenalterol. Sustained oral treatment with prenalterol did not have the beneficial effects on cardiac function produced by intravenous treatment and in fact had deleterious effect on the measured indices of cardiac function during exercise.

Administration, Oral↗
PubMed1983

Incremental value of clinical assessment, supine exercise electrocardiography, and biplane exercise radionuclide ventriculography in the prediction of coronary artery disease in men with chest pain.

The incremental value of clinical assessment, exercise electrocardiography (ECG) and biplane radionuclide ventriculography (RVG) in the prediction of coronary artery disease (CAD) was assessed in 105 men without myocardial infarction who were undergoing coronary angiography for investigation of chest pain. Independent clinical assessment of chest pain was made prospectively by 2 physicians. Graded supine bicycle exercise testing was symptom-limited. Right anterior oblique ECG-gated first-pass RVG and left anterior oblique ECG-gated equilibrium RVG were performed at rest and exercise. Regional wall motion abnormalities were defined by agreement of 2 of 3 blinded observers. A combined strongly positive exercise ECG response was defined as greater than or equal to 2 mm ST depression or 1.0 to 1.9 mm ST depression with exercise-induced chest pain. A multivariate logistic regression model for the preexercise prediction of CAD was derived from the clinical data and selected 2 variables: chest pain class and cholesterol level. A second model assessed the incremental value of the exercise test in prediction of CAD and found 2 exercise variables that improved prediction: RVG wall motion abnormalities, and a combined strongly positive ECG response. Applying the derived predictive models, 37 of the 58 patients (64%) with preexercise probabilities of 10 to 90% crossed either below the 10% probability threshold or above the 90% threshold and 28 (48%) also moved across the 5 and 95% thresholds. Supine exercise testing with ECG and biplane RVG together, but neither test alone, effectively adds to clinical prediction of CAD. It is most useful in men with atypical chest pain and when the ECG and RVG results are concordant.

Adult↗
PubMed1983

Recent experience with transeptal catheterization.

We report our recent experience of 207 consecutive transeptal catheterizations performed in the following groups of patients: aortic valve disease in 152, mitral valve disease in 20, combined aortic and mitral valve disease in 11, hypertrophic obstructive cardiomyopathy in 11, assessment of prosthetic cardiac valves in nine, and four miscellaneous. Transeptal catheterization failed in 20 patients. There was no attempt to advance the transeptal catheter from the left atrium into the left ventricle in 18 patients, and failure to advance the transeptal catheter from the left atrium into the left ventricle occurred in 13 patients. Transeptal catheterization was achieved in a mean time of 9.7 +/- 4.6 SD min. There were no deaths, two major and four minor complications. We conclude that transeptal catheterization remains a useful technique that in experienced hands is both rapid and safe.

Adult↗
PubMed1983

Amiodarone therapy for life threatening or refractory cardiac arrhythmias.

Amiodarone was used in 40 patients with life-threatening or refractory tachyarrhythmias. Eighteen patients had recurrent ventricular tachycardia of whom 13 had suffered a cardiac arrest. Control has been excellent or good in 17 of these 18 patients during an average follow-up period of 10 months. A further 22 patients had supraventricular arrhythmias, including three with Wolff-Parkinson-White syndrome and paroxysmal atrial fibrillation. In 20 of these control has been excellent or good. The mean daily maintenance dose of amiodarone was 300 mg for patients with ventricular tachyarrhythmias and 200 mg for those with supraventricular tachyarrhythmias. Side-effects were common and included corneal microdeposits, skin rash and discolouration, alteration in thyroid function, and symptomatic bradycardia. Serious adverse effects were uncommon however and necessitated discontinuation of the drug in only two patients. Amiodarone did not appear to precipitate or exacerbate cardiac failure in any patient although many had severe left ventricular dysfunction. We conclude that amiodarone is effective in the therapy of life-threatening or refractory cardiac arrhythmias.

Adolescent↗
PubMed1982

Effects of verapamil on the electrophysiologic properties of the accessory pathway in patients with the Wolff-Parkinson-White syndrome.

The effects of intravenous verapamil on the electrophysiologic properties of the accessory pathway in 12 patients with symptomatic Wolff-Parkinson-White syndrome were studied using intracardiac electrical recordings. In 11 of the 12 patients it was possible to induce a reentrant supraventricular tachycardia with programmed atrial or ventricular pacing. After verapamil it was still possible to induce supraventricular tachycardia in 6 of the 11 patients; however, the mean cycle of length of the tachycardia increased from a control value of 330 +/- 20 ms (mean +/- standard error of mean) to 369 +/- 21 ms (p less than 0.05). Although verapamil had no significant effect on the anterograde refractory period of the accessory pathway as measured by the extrastimulus technique, it significantly increased maximal 1:1 atrioventricular (AV) conduction through the accessory pathway to incremental high rate atrial pacing in 10 of the 12 patients (control value 227 +/- 10 beats/min, value after verapamil 258 +/- 14 beats/min, p less than 0.001). In 4 patients in whom episodes of atrial fibrillation could be compared before and after verapamil, the drug decreased the average R-R interval from a control value of 327 +/- 27 ms to 282 +/- 28 ms (p less than 0.05) and decreased the shortest R-R interval between preexcited beats from a control value of 237 +/- 21 ms to 209 +/- 18 ms (p less than 0.05). It is concluded that in patients with symptomatic Wolff-Parkinson-White syndrome, verapamil may increase the ventricular response through the accessory pathway if atrial fibrillation occurs. This finding, which is of potential clinical significance, could not have been predicted from conventional anterograde refractory period estimations.

Adult↗
PubMed1982

Adverse interaction between beta-adrenergic blocking drugs and verapamil--report of three cases.

Three patients with ischaemic heart disease developed profound cardiac failure, hypotension and bradycardia during combined therapy with verapamil and beta-adrenergic blocking drugs. This clinical picture resolved completely with cessation of the combined therapy. Baseline left ventricular function, assessed by cardiac catheterisation or nuclear angiography, was normal in two patients and only mildly reduced in the other. Simultaneously administration of beta-adrenergic blocking drugs and verapamil may result in profound adverse interactions and should only be administered with great caution.

Adrenergic beta-Antagonists↗
PubMed1982

Right atrial thrombus simulating myxoma on M-mode echocardiography in a patient with pulmonary emboli.

Echoes from a right atrial mass in a patient with pulmonary embolism simulated a typical echocardiographic appearance of a right atrial myxoma. The patient was admitted with recurrent pulmonary emboli and had evidence of deep venous thrombosis on venography. M-mode echocardiography showed the appearance of a right atrial mass and right atrial angiography confirmed the presence of a mass prolapsing from right atrium into right ventricle. Subsequent 2-dimensional echocardiography and careful repeat M-mode echocardiography failed to demonstrate the mass suggesting embolisation to the lungs or lysis of the thrombus.

Adult↗
PubMed1982

Radionuclide angiographic assessment of global and segmental left ventricular function at rest and during exercise after coronary artery bypass graft surgery.

Left ventricular ejection fraction (LVEF) was measured by radionuclide angiography at rest and during supine bicycle exercise before and 3 months after coronary artery bypass graft surgery (CABG) in 20 patients with chronic stable angina. The right anterior oblique gated first-pass technique was used to assess LVEF response to maximal exercise (Wmax), while the left anterior oblique equilibrium-gated technique was used to assess LVEF and relative LV volume changes during graded submaximal exercise. Mean LVEF was unchanged at rest after CABG by both the first-pass (60 +/- 12% vs 60 +/- 12%) and equilibrium-gated (61 +/- 13% vs 62 +/- 13%) measurements. At Wmax, mean first-pass LVEF was significantly higher postoperatively than preoperatively (63 +/- 17% vs 53 +/- 17%; p less than 0.01) with a higher Wmax (750 +/- 182 vs 590 +/- 202 kpm/min; p less than 0.001) and higher rate-pressure product (302 +/- 59 vs 222 +/- 57 units; p less than 0.001). Similarly, equilibrium-gated LVEF levels during graded exercise, using stepwise regression analysis, were significantly higher postoperatively than preoperatively (p less than 0.001); at the highest graded work load, they averaged 63 +/- 19% postoperatively and 53 +/- 17% preoperatively, with higher work loads (500 +/- 190 vs 417 +/- 155; p less than 0.05) and higher rate-pressure products (271 +/- 55 vs 207 +/- 53; p less than 0.001). The increase in exercise LVEF after surgery was due to a marked decrease in the ratio, relative to resting values, of counts-based end-systolic volumes during submaximal exercise (preoperatively 1.91 +/- 1.04; postoperatively 1.14 +/- 0.46; p less than 0.01). The five subjects in whom LVEF decreased significantly during exercise postoperatively all had one or more blocked or stenosed grafts. This study documents, by two independent radionuclide techniques, an improved LVEF during exercise at an increased maximal work capacity and rate-pressure product 3 months after successful CABG.

Adult↗
PubMed1980

The effect of a selective beta adrenergic blocking agent on ventricular arrhythmias in the first year following myocardial infarction.

Fifty-five patients with recent acute myocardial infarction entered a single-blind cross-over trial to assess the effect of oral practolol 200 mg twice daily on the incidence and nature of ventricular arrhythmias in the first year following myocardial infarction. Patients had 24-hour Holter electrocardiogram tape monitoring at two weeks following infarction and at three-monthly intervals for one year. Twenty-six patients completed the full year of the trial with 12% of tape recordings technically unsatisfactory. A total of 46 periods of comparison of the action of practolol versus placebo therapy were available in thirty patients. Whilst receiving the selective beta adrenergic blocking agent, practolol, there was a significant reduction in the percentage of studied hours during which salvos of ventricular premature beats occurred (P < 0.025), however the percentage of patients in whom salvos were recorded was unchanged. The incidence of all other ventricular arrhythmias was not reduced in the practolol group. When the effect of practolol was related to the site of infarction, anterior or inferior, there was no significant reduction in the incidence of ventricular arrhythmias.

Adult↗
PubMed1979

Series on pharmacology in practice. 2. Antiarrhythmic drug therapy.

The selection of appropriate antiarrhythmic drug therapy depends on a knowledge of the drugs available, their spectrum of action, their pharmacokinetics, and their major side effects. It is important to know how the pharmacokinetics of a drug vary with different disease states so that appropriate adjustments to dosage can be made. Drugs with similar actions can be assigned into groups, and five different groups can be identified. The commonly used antiarrhythmic drugs are reviewed, and some of the newer drugs are discussed.

Anti-Arrhythmia Agents↗
PubMed1978

Multiple-gated acquisition cardiac blood-pool isotope imaging. Evaluation of left ventricular function correlated with contrast angiography.

Thirty-one patients were assessed by the multiple-gated acquisition cardiac blood-pool isotope-imaging technique using radiolabeled albumin within 24 hours of biplane contrast ventriculography. Data from the imaging method were analyzed by a semiautomatic technique with computer-generated edge detection and background subtraction. An excellent correlation was observed between ejection fractions determined with multiple-gated isotope imaging and those obtained by biplane contrast ventriculography (r = 0.93), and the same was true for average ejection rates (r = 0.80). For assessment of wall motion with this imaging technique, the anterior and the left anterior oblique left ventricular views were divided into nine segments, and a score was assigned to each segment based on the degree of wall motion. The cumulative anterior and left anterior oblique scores correlated well with the score from biplane contrast ventriculography (r = 0.90), and in 94% of segments in the left anterior oblique projection the assessment with multiple-gated isotope imaging was the same as or varied by only one class from the assessment by biplane contrast ventriculography. The multiple-gated acquisition cardiac blood-pool isotope-imaging technique is thus a valuable noninvasive method for assessing left ventricular function as measured by ejection fraction, ejection rates, and wall motion.

Adult↗
PubMed1977

Pulmonary embolism secondary to anomalies of deep venous system of the leg.

Two cases of recurrent pulmonary emboli secondary to thrombosis in anomalies of the deep veins of the lower limb are presented. In both cases the source of emboli was not evident clinically, and it was only after venography that the venous anomalies were discovered, both being confined to one limb and amenable to surgical intervention. Such anomalies have not previously been reported as sources of venous thromboembolism in adults. The importance of venography in establishing the source of pulmonary emboli, especially when recurrent, is stressed.

Adult↗