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Biomedical subjects

J G Porterfield

Publications and source records attributed to J G Porterfield.

12 recordsLinked to original sources
PubMed1991

Ninety-six episodes of spontaneous ventricular tachycardia in 1 week: success of ramp pacing by a pacer-cardioverter-defibrillator.

This case report describes the flexibility and usefulness of a pacer-cardioverter-defibrillator for the management of a 63-year-old patient with malignant ventricular tachyarrhythmias. Ninety of 96 episodes of ventricular tachycardia were terminated successfully with ramp pacing in a 1-week period. In those patients who have frequent episodes of ventricular tachycardia that respond to antitachycardia pacing, the multifunction device can add to the patient's comfort and increase acceptance of this type of device.

Cardiac Pacing, Artificial↗
PubMed1991

Long-term community hospital experience with the internal defibrillator.

Seventy-seven patients with drug refractory ventricular tachycardia (57) and ventricular fibrillation (20) received the implantable defibrillator. There were 55 men and 22 women with a mean age of 63 +/- 10 years. The anatomical diagnoses were coronary artery disease in 61 patients, cardiomyopathy in 15 patients, and aortic stenosis in one patient. The mean ejection fraction was 32 +/- 12%. Concurrent surgery at defibrillator implantation was coronary bypass in eight patients and aortic valve replacement in one patient. There were no intraoperative mortalities. The mean ventricular fibrillation termination threshold was 13 +/- 6 joules. During a follow-up period of 16 +/- 10 months (range 2-40 months) four patients died: electrical mechanical dissociation (two patients), respiratory failure, and sepsis. Thirty-eight patients (51%) continued receiving antiarrhythmic drug therapy, with quinidine sulfate and procainamide being the most frequently utilized agents. Fifty-four patients (72%) have received a mean of 9 +/- 10 shocks (range 1-44). Implantable defibrillators are often needed in patients seen in large community hospitals. This technology can be administered successfully in this setting with complications and results comparable to those reported from university hospitals. Implantable defibrillators are effective in preventing arrhythmic death and can be used with low risk to the patients.

Anti-Arrhythmia Agents↗
PubMed1991

A prospective study utilizing a transtelephonic electrocardiographic transmission program to manage patients in the first several months post-ICD implant.

We prospectively enrolled 20 consecutive patients (11 men and 9 women; mean age 63 +/- 9.5 years) post-AICD implant in a transtelephonic electrocardiographic transmission (TET) program. The monitor was chosen for its retrograde (30 seconds) and antegrade memory capabilities (45 seconds). The patients were discharged from the hospital after receiving instructions to utilize the system for any cardiac symptoms. The monitor was worn 1-3 months (mean 2.5 +/- 0.7 months). During the follow-up period there were 54 TETs received. Nine were for documented AICD discharges, 19 were for symptoms associated with arrhythmias (11 of these 19 reported AICD discharges that were not documented), and 26 for symptoms not associated with arrhythmias. Eight of the 9 AICD discharges documented were appropriate for ventricular tachycardia (mean 185 +/- 40 beats/min). The arrhythmias associated with symptoms were: atrial fibrillation (12); nonsustained ventricular tachycardia (3); ventricular couplets (2); ventricular premature beats (10); and atrial premature contractions (2). Several TETs documented multiple arrhythmias. The most common symptoms not associated with arrhythmias were shortness of breath, dizziness, chest pain, and nervousness. Office interrogation of the AICDs revealed 12 of the 20 patients (60%) had received AICD discharges, with 5 of these 12 patients unaware of this occurring. We found the TET monitoring system a useful tool in the management of the AICD patient the first several months postoperatively. We were able to assess device function and avoid unnecessary office visits and/or hospitalizations.

Atrial Fibrillation↗
PubMed1987

Amiodarone-associated pulmonary toxicity. A clinical and pathologic study of eleven cases.

The new anti-arrhythmic agent, amiodarone, is increasingly recognized as a cause of pulmonary toxicity (APT). In the present series, 11 of 171 patients (6.4%) receiving the drug had APT develop. Clinical symptoms varied from mild cough and dyspnea to acute respiratory failure. Chest x-rays demonstrated alveolar and/or interstitial opacities in all 11 patients. The microscopic appearance of APT resembled that seen in lung injury from other drugs. The features were those of diffuse alveolar damage, ranging from the early acute to the organizing phase. Mural and intraalveolar foam cells were a prominent component. The epithelial origin of these cells was confirmed by positive immunoperoxidase staining for carcinoembryonic antigen. They were further identified as type II pneumocytes by electron microscopic examination. These findings support the concept that amiodarone is responsible for a drug-induced phospholipidosis. APT was clinically reversible in all patients; however, five patients (45%) died of arrhythmia shortly after discontinuation of amiodarone.

Adult↗