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J M Juanteguy

Publications and source records attributed to J M Juanteguy.

18 recordsLinked to original sources
PubMed1988

Implantation of the automatic implantable cardioverter defibrillator.

Since February 1980 the automatic implantable cardioverter defibrillator has been implanted in over 1,500 patients. Sudden death rates have been reduced to 2%-4% annually. This report reviews the implantation techniques, their indications, and our clinical experience in 200 patients.

Arrhythmias, Cardiac↗
PubMed1986

[Implantable defibrillators. Clinical experience].

The clinical experience with the Automatic Implantable Cardioverter-Defibrillator (AICD) now extends to over 800 patients suffering from malignant ventricular arrhythmias, most of them survivors of sudden cardiac death. This device monitors cardiac rhythm for long periods of time, identifies ventricular fibrillation and life-threatening ventricular tachycardias, and then restores normal heart action with effective electrical discharges. The AICD practically eliminates the need for trained personnel and the time constraints associated with conventional out-of-hospital resuscitation, significantly decreasing the arrhythmic and total mortality rates of the implantees. Through August, 1985, 130 consecutive patients underwent implantation of the AICD at The Johns Hopkins Hospital in Baltimore; the one-year mortality due to arrhythmias was 1.7%. These results are similar to those reported by other centers. Thus, the growing clinical experience with the automatic implantable cardioverter-defibrillator has demonstrated a marked reduction of the mortality rate of the implantees.

Adolescent↗
PubMed1985

Recent clinical experience with the automatic implantable cardioverter-defibrillator.

The automatic implantable cardioverter-defibrillator is an electronic device designed to monitor the heart continuously, identify ventricular tachycardias and ventricular fibrillation, and terminate the life-threatening arrhythmias with an internal countershock. This device has been proved to be safe and effective, and its use has led to a significant decrease of arrhythmic mortality in the implantees.

Arrhythmias, Cardiac↗
PubMed1985

Clinical experience with the automatic implantable defibrillator.

Since February 1980, worldwide, over 400 survivors of sudden arrhythmic death have been treated with the automatic implantable defibrillator. Recently, the device has been further improved; it is now a cardioverter-defibrillator (AICD), able to treat ventricular tachycardias as well as ventricular fibrillation. There are two defibrillating electrodes which are used also for waveform analysis; one is located in the superior vena cava, the other is placed over the cardia apex. A third bipolar right ventricular electrode serves for rate counting and R-wave synchronization. When ventricular fibrillation occurs, a 25-joule pulse is delivered; when ventricular tachycardia faster than a preset rate is detected, the discharge is R-wave synchronized. Special batteries can deliver over 100 shocks or provide a three-year monitoring life. Implantation of the device can be achieved through a thoracotomy or by a subxiphoid or a subcostal approach. Thus far, the longest follow-up period has been 58 months. Actuarial analysis shows the one-year mortality attributed to arrhythmias reduced to less than 2%. Thus, the automatic cardioverter-defibrillator can reliably identify and correct potentially lethal ventricular tachyarrhythmias, leading to a substantial increase in survival in properly selected high-risk patients.

Death, Sudden↗
PubMed1984

The automatic implantable cardioverter-defibrillator.

The automatic implantable cardioverter-defibrillator is an electronic device designed to monitor the heart continuously, to identify malignant ventricular tachyarrhythmias, and then to deliver effective countershock to restore normal rhythm. There are two defibrillating electrodes which are also used for waveform analysis; one is located in the superior vena cava, the other is placed over the cardiac apex. A third bipolar right ventricular electrode serves for rate counting and R-wave synchronization. When ventricular fibrillation occurs, a 25 joule pulse is delivered; when ventricular tachycardia faster than a preset rate is detected, the discharge is R-wave synchronized. The device can recycle three times if required. Special batteries can deliver over 100 shocks or provide a 3-year monitoring life. Implantation of the device is made either through a thoracotomy or by a subxiphoid approach. Thus far, the device has been implanted in 160 patients with a follow-up of 42 months. Acceleration of ventricular tachycardia to a faster rhythm or to ventricular fibrillation occurred only rarely and is dealt with most successfully through recycling. Actuarial analysis of the initial 52 patients has indicated 22.9% one-year total mortality, a 52% decrease from the 48% mortality that would be expected in the same group of patients without the device; the mortality attributed to arrhythmias was only 8.5%. In conclusion, the automatic cardioverter-defibrillator can reliably identify and correct potentially lethal ventricular tachyarrhythmias, leading to a substantial increase in survival in properly selected high-risk patients.

Death, Sudden↗
PubMed1984

Automatic implantable cardioverter-defibrillator structural characteristics.

There are a number of equipment options and surgical techniques available for automatic implantable cardioverter-defibrillator implantation. The system can be successfully used even in problem cases where restrictions may be imposed because of physical build or the presence of other implanted devices. The sensing requirements and energy output of the units can be tailored to the exact needs of the particular patient. Battery life and device function are easily monitored periodically following implantation, making possible elective replacement of the pulse generator when the batteries become depleted.

Arrhythmias, Cardiac↗
PubMed1984

Clinical performance of the implantable cardioverter-defibrillator.

The automatic implantable cardioverter-defibrillator has been implanted in 276 patients with ventricular tachyarrhythmias refractory to therapy with a follow-up period up to 50 months (average 9.75 months). The functional performance of the device has so far been most encouraging. The risks and complications associated with its use are acceptable and quite similar to those observed in patients with implanted pacemakers. Acceleration of ventricular tachycardia to a faster rhythm or to ventricular fibrillation is dealt with successfully through recycling. Actuarial analysis indicates that the device has a significant impact on the survival rate of the implantees, reducing the one-year mortality rate attributed to arrhythmias to only 2%.

Actuarial Analysis↗
PubMed1984

Use of the automatic implantable cardioverter-defibrillator in the treatment of malignant ventricular tachyarrhythmias.

Since February, 1980 nearly 200 automatic cardioverter - defibrillators have been implanted in patients with malignant ventricular arrhythmias. The currently-employed device weighs 298 grams and occupies a volume of 162 cm3. There are two defibrillation electrodes which also serve as sensors: one, an intravascular catheter placed in the superior vena cava at the level of the right atrium; the other, a flexible rectangular patch placed extrapericardially over the apex of the heart. Additionally, there is a bipolar right ventricular electrode for rate counting and R-wave synchronization which will eventually be used for pacing as well. The unit is powered by lithium batteries with a projected monitoring life of three years, or the capability of discharging approximately 100 times. The arrhythmia detector activates the cardioverter -defibrillator about 15 to 20 seconds after diagnosing a "treatable" arrhythmia, identified on the basis of a striking absence of isoelectric potential segments characteristic of ventricular fibrillation and many ventricular tachycardias. The diagnosis also requires fulfillment of individually-programmed heart rate criteria. If the initial discharge of 25 joules is ineffective, the device will recycle as many as three times with a final pulse of up to 42 joules. Of the twelve nonsurvivors among the initial 52 implantees who underwent implantation through September, 1982, only four deaths were unwitnessed and considered to be sudden and arrhythmic; the other eight deaths were due to heart failure or unrelated causes. Thus, from a predicted mortality of 48% in the same group of patients if the automatic defibrillator had not been implanted, the "sudden death" mortality was reduced to 8.5%.

Electrocardiography↗
PubMed1981

Results of polytetrafluoroethylene grafts in the femoropopliteal region: two year evaluation of 146 bypass procedures.

One hundred twenty patients, who underwent femoropopliteal bypass procedures using polytetrafluoroethylene (PTFE) grafts, are reviewed. There were 70 male and 50 female patients ranging in age from 42 to 84 years, the mean age being 64.27 years. A total of 140 procedures were performed for tissue loss or impending tissue loss; only 26 procedures had been done for limiting claudication. Review of the results showed a cumulative patency of 83.86%, t two years. The results for good run off showed a patency of 99.07% at two years, while the cases with poor run off, the patency was 47.0%. There were no early mortalities. Two patients, however, died during the follow-up period. Of the 17 amputations required, eight were defined as major and nine as minor amputations. The series is compared with a series of saphenous vein bypasses and also one using Dacron prosthesis.

Adult↗