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Biomedical subjects

J Pella

Publications and source records attributed to J Pella.

At least 19 recordsLinked to original sources
PubMed1994

[Transesophageal ventricular stimulation and ventricular tachycardia in the period before implantation of a cardioverter-defibrillator].

The administration of an implantable cardioverter-defibrillator (ICD) is the method of choice in life-threatening ventricular tachyarrhythmias. This effective non-pharmacological intervention was a great advance in the prevention of sudden cardiac death. As to ventricular tachycardias, relapsing ventricular tachycardias based on ischaemic alone need not influence ventricular tachycardia. The mechanism of ventricular tachycardia in ischaemic heart disease is reentry and therefore this arrhythmia can be terminated not only by a defibrillation discharge but also by antitachycardiac stimulation. Various types of antitachycardiac stimulation are part of modern types of ICD. Evidence of the effectiveness of antitachycardiac stimulation (electrophysiological examination) permits to use it also by the transoesophageal approach. This treatment can be very effective and we can thus overcome the period before the definite administration of an ICD, as indicated by the case described.

Aged↗
PubMed1994

[Adenosine triphosphate and supraventricular tachycardia].

UNLABELLED: Intravenously administered adenosine triphosphate (ATP) converts some supraventricular tachycardias to a sinus rhythm. Temporary atrioventricular block can help with the differentiation of different forms of supraventricular tachycardia. METHOD: Twenty-one patients with different forms of supraventricular tachycardia were subjected to electrophysiological examination for diagnostic or therapeutic (ablation) purposes. During tachycardia (after 5 minutes duration) ATP Spofa was administered by the i.v. route within 3 s into the cubital vein--0.3 mg per 1 kg body weight. RESULTS: One patient had two forms of supraventricular tachycardia. In the first group with auricular fibrillation (AF, n = 10), with auricular flutter (AFL, n = 5) and with automatic auricular tachycardia (AAT, n = 1) tachycardia was not eliminated by intravenously administered ATP. In the second group the authors were always able to eliminate paroxysmal supraventricular tachycardia, AV nodal reciprocal (AVNRT, n = 4) and atrioventricular reciprocal tachycardia (AVRT, n = 2) by intravenously administered ATP. CONCLUSIONS: 1. The authors conclude that ATP exerts an antiarrhythmic effect by blocking the reentry circuit in the AV node, i.e. it converts reentry supraventricular tachycardias (AVNRT and AVRT) to a sinus rhythm after reciprocal atrial activity. 2. The effect on atria can be proarythmogenic. 3. The authors did not confirm the effect on abnormal automaticity.

Adenosine Triphosphate↗
PubMed1992

[Rapid continuous stimulation of the atrium (overdrive) in the treatment of refractory supraventricular tachycardia].

In 71 patients, divided into four groups by the type of supraventricular tachycardia (SVT) during electrophysiological examination, 918 stimulations were implemented by the method of rapid continuous stimulation of the atria (overdrive) in order to interfere with a SVT paroxysm. In addition to characteristics of tachycardia the authors evaluated parameters of overdrive stimulation, i.e. the duration of the stimulation cycle (CL STIM), the ratio CL STIM/CL SVT, the number of stimuli required to terminate tachycardia (N STIM) and their mutual relations. In the group of atrioventricular reciprocal tachycardias (WPW, n = 17) the effectiveness was 50.4%, CL SVT 334 +/- 43 ms, the ratio CL STIM/CL SVT 78.3 +/- 12%, the median of N STIM 14 +/- 6. In the group of AV nodal tachycardias (AVNR, n = 26) the effectiveness is 53.1%, CL SVT 356 +/- 70 ms, CL STIM/CL SVT 77 +/- 8.6%. In the group of atrial tachycardias (AT, n = 5) the effectiveness was 62.3%, CL SVT 348 +/- 24 ms, CL STIM/CL SVT 73.7 +/- 7.5%, N STIM 6 +/- 4. In the group of atrial flutter (AFL, n = 23) the effectiveness was 9.2%, CL SVT 226 +/- 29 ms, CL STIM/CL SVT 84.5 +/- 8.2%, N STIM 22.5 +/- 9. The effectiveness of overdrive stimulation in AFL is significantly lower than in other groups of SVT. The regression correlation in the entire group of tachycardias for calculation of a suitable duration of CL STIM--0.855 x CL SVT--28 (ms), the median number of stimuli N STIM 14 +/- 7.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1992

[Echocardiographic indicators in various stages of hypertension and their relation to the incidence of dysrhythmia].

The authors present a group of 143 hypertonic patients divided into three subgroups by the stage of hypertension (WHO). The objective was to detect an association between the incidence of cardiac dysrhythmias and the stage of hypertension and left ventricular (LV) morphological and functional parameters resp. which were assessed by echocardiography (ECHOCR). The authors investigated the systolic pressure (BPs) and diastolic pressure (BPd) on admission and the following ECHOCR parameters: weight of the left ventricle, tension of the LV wall during end systole, maximum tension of the LV wall, fractionated shortening of the Lv wall and the relative width of the LV wall. Comparison of clinical and ECHOCR parameters in groups revealed significantly lower values of BPs on admission in patients in the first stage of hypertension (p less than 0.01), the tension of the LV wall during end systole was in the third stage of hypertension significantly higher (p less than 0.01). In patients in the first stage there was a positive correlation between systolic pressure on admission and the fractional shortening of the LV (r = 0.568, p less than 0.025) and between diastolic pressure and the maximum tension of the LV wall (r = 0.572, p less than 0.025). They did not reveal an association between different stages of hypertension and the incidence of dysrhythmias. The group of patients with chronic atrial fibrillation had significantly larger dimensions of the left atrium, as compared with other groups of dysrhythmias. The authors were unable to reveal an association between the assessed morphological and functional parameters of the LV in different stages of hypertension and the incidence of dysrhythmias.

Aged↗
PubMed1992

[Uric acid and sinoatrial node function].

In a retrospective investigation comprising 54 patients the authors assessed the relationship between the function of the sinoatrial node and raised serum uric acid levels. The function of the sinoatrial node was expressed by the maximal value of the corrected recovery time of the sinoatrial node. No statistically significant correlation was found.

Adult↗
PubMed1990

[Does the left atrial dimension predict the short-term effect of electric cardioversion?].

The authors evaluate in their retrospective investigation the influence of the left atrium, assessed by echocardiography, on the short-term effect of electric cardioversion in auricular fibrillation. The group comprises 44 patients divided into four groups: ischaemic heart disease, cardiomyopathy and specific myocardial affection, mitral stenosis and idiopathic fibrillation. The authors did not find a significant difference between the left atrial diameter in patients with successful electric cardioversion (ECV) (44.4 +/- 8.2 mm) and patients with not successful ECV (43.4 +/- 6.7 mm). The authors did not prove the influence of age and aetiology of fibrillation on the effect of ECV. The size of the left atrium alone does not possess a significant predictive value when estimating the short-term effect of ECV.

Adult↗
PubMed1990

[Paroxysmal atrioventricular block].

The authors analyzed paroxysmal atrioventricular blocks which were not frequency-dependent. It was a clinical, electrocardiographic and electrophysiological evaluation. The authors draw attention to the pitfalls of diagnosis and emphasize that the problem of interpretation of atrioventricular (intraventricular) conductivity is unequivocally associated with the problem of indication of permanent cardiac pacing. Based on their own experience, the authors describe the procedure used for establishment of the diagnosis of paroxysms of atrioventricular blocks. What are the main conclusions? 1. In the first place it is necessary to pay attention to the history of syncopes. 2. On the conventional ECG we find usually disorders of atrioventricular and intraventricular conductivity. 3. Electrophysiological examination should be always supplemented also by pharmacological intervention, using Gilurytmal by the i.v. route.

Aged↗
PubMed1990

[Experience with permanent cardiac pacemakers in the East Slovakian Region 1978-1987].

The authors present a group of patients where in the course of the 10-year period of 1978-1987 a permanent pacemaker was implanted. 587 primary implantations were made and 327 exchanges of cardiac pacemakers. The mean age in the group of primary implantations was 70.4 +/- 10.3 years, in the group of exchanges 70.4 +/- 10.6 years. n 98.8% pacemakers VVI and VOO made in Czechoslovakia were implanted. Indications for primary implantation were in 64% atrioventricular block (AV) grade III, in 11% AV block grade II, in 22% disease of the sinoatrial node and in 4% other dysrhytmias. The age category above 60 years accounts for 85.5% in the group of primary implantations. A positive feature is the low incidence of complications of surgical and technical nature. An unfavourable feature is that almost all implanted devices were the simplest single electrode systems where the frequency cannot be adapted and where other parameters cannot be changed.

Adolescent↗
PubMed1990

[Atypical ventricular tachycardia and atrioventricular blockade].

The authors submit a clinical and electrocardiographic analysis of five patients with atypical ventricular tachycardia with atrioventricular block of an advanced degree. The incidence is relatively rare--cca 1% patients with atrioventricular block are threatened by this type of tachycardia. In these patients there are always reduced serum potassium levels and a longer QT interval, as compared with patients without tachycardia. In two instances there was an association with the use of drugs (Furosemide and Thioridazine) and these patients developed tachycardia even during permanent pacing. Correction of the internal environment and discontinuation of drugs proved therefore decisive, as permanent pacing alone did not always suffice to prevent tachycardia. Without medication atypical ventricular tachycardia develops, in the author's opinion, most probably when bradycardia has persisted for a prolonged period.

Aged↗
PubMed1989

[Löffler's endocarditis].

The authors describe Loeffler's endocarditis and the treatment of this clinical entity. Among diagnostic methods which drew attention to a cardiac affection associated with eosinophilia, non-invasive examination methods were of decisive importance. They comprised conventional electrocardiographic examination, X-ray of the chest and two-dimensional echocardiography.

Endocarditis↗