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Biomedical subjects

L S Griffith

Publications and source records attributed to L S Griffith.

At least 55 records · Page 3Linked to original sources
PubMed1986

Use of the Diagnostic Interview Schedule in patients with diabetes mellitus.

In routine clinical practice and in research interviews like the Diagnostic Interview Schedule (DIS), symptoms attributed to physical illness are excluded from contributing positively toward psychiatric diagnoses. The maximal rate of underdiagnosis which results from this diagnostic rule was determined in 114 patients with diabetes mellitus. When symptoms attributed to diabetes (total = 296, mean = 2.6 per patient) were discounted, 256 diagnoses were made. Eighteen additional diagnoses (a 6.7% increase) were appreciated when these excluded symptoms were considered as psychiatrically significant; however, only two of these new diagnoses were given to patients previously without a psychiatric diagnosis. The authors concluded that the DIS is sensitive in its detection of psychiatric illness in diabetes and perhaps other physical illnesses as well.

Adult↗
PubMed1986

The use of ambulatory monitoring in the prognostic evaluation of patients with sustained ventricular tachycardia treated with amiodarone.

We recently reported a retrospective experience with serial Holter monitoring as a guide to therapy in patients with sustained ventricular tachycardia treated with amiodarone. To confirm and substantiate these findings, a prospective study was designed that included baseline 24 hr Holter monitoring and serial Holter monitoring after 1 week of therapy with amiodarone. Fifty-two patients with documented sustained ventricular tachycardia who manifest nonsustained ventricular tachycardia on baseline Holter monitoring were treated with amiodarone. Thirty-four patients (group I) had nonsustained ventricular tachycardia completely suppressed and 18 patients (group II) had continued nonsustained ventricular tachycardia on serial Holter monitoring performed on days 8, 9, and 10 of therapy. At 11.6 +/- 1.0 (mean +/- SE) months follow-up, three (9%) group I patients and 12 (67%) group II patients had recurrent sustained ventricular tachycardia or sudden cardiac death (p less than .01). The sensitivity, specificity, positive and negative predictive value, and predictive accuracy of ventricular tachycardia on 24, 48, and 72 hr Holter monitoring over days 8, 9, and 10 for predicting recurrent sustained ventricular tachycardia or sudden cardiac death were analyzed. The positive and negative predictive values were 89% and 84%, 69% and 89%, and 67% and 91% for 24, 48, and 72 hr Holter monitoring, respectively. Overall predictive accuracy was 85%, 83%, and 83%, respectively. We conclude that early Holter monitoring is useful in assessing the clinical efficacy of amiodarone in patients with sustained ventricular tachycardia who manifest nonsustained ventricular tachycardia on baseline Holter monitoring.

Amiodarone↗
PubMed1985

Ambulatory electrocardiographic recordings at the time of fatal cardiac arrest.

The relation between arrhythmias at cardiac arrest and the outcome of arrest is poorly understood. The Holter monitor tracings of 13 patients were reviewed after they sustained an in-hospital cardiac arrest during ambulatory electrocardiographic monitoring. All had a prior cardiac arrest or cardiac syncope. Twelve patients had ventricular tachycardia (VT) as their initial arrest arrhythmia and 1 patient had bradycardia followed by ventricular fibrillation (VF). VT degenerated to VF in 10 of 12 patients after a mean interval of 96 +/- 31 seconds (+/- standard error of the mean). The number of VT runs increased significantly during the hour immediately preceding arrest (p = 0.004). Despite prompt resuscitation efforts in 12 patients, only 6 survived. The 6 survivors and 6 nonsurvivors were not different with regard to age, ejection fraction, extent of coronary artery narrowing and time to first defibrillation. However, degeneration to VF within 30 seconds of arrest (5 of 6 nonsurvivors and 1 of 6 survivors, p = 0.04) and a slower rate of VT at the onset of arrest (166 beats/min in nonsurvivors and 227 beats/min in survivors, p = 0.02) were associated with unsuccessful resuscitation.

Adult↗
PubMed1985

Programmed electrical stimulation and long-term follow-up in asymptomatic, nonsustained ventricular tachycardia.

Thirty-three patients with ventricular tachycardia (VT) (3 or more beats, less than 30 seconds in duration, rate more than 100 per minute) on 24-hour Holter monitoring and no history of clinical arrhythmia (presyncope, syncope or sudden death) were studied using programmed electrical stimulation (PES). PES induced VT in 14 patients (42%), sustained VT in 7 (21%) and nonsustained VT in 7 (21%). Inducible VT was associated with underlying heart disease in 9 of 19 patients with coronary artery disease, 3 of 6 patients with idiopathic dilated cardiomyopathy and 2 of 4 patients with mitral valve prolapse. Patients without structural heart disease did not have inducible VT. Ejection fraction (EF) was not significantly different in patients with or without inducible VT. Twenty-three patients were discharged with drug therapy and 10 patients without therapy. At 23 +/- 16 months (mean +/- standard deviation) follow-up, 28 patients (85%) were alive, 4 (12%) had died from a cardiac cause (EF 49 +/- 17% vs 28 +/- 20%, p less than 0.03). Another patient died from cerebrovascular accident. Twenty-six patients (79%) were free of clinical arrhythmia and 7 patients (21%) had arrhythmic events (EF 49 +/- 18% vs 31 +/- 17%, p less than 0.04). Two of 8 patients with noninducible VT who were discharged without drug treatment had clinical arrhythmic events and neither of 2 patients with inducible VT discharged off drugs had such events.(ABSTRACT TRUNCATED AT 250 WORDS)

Cardiac Pacing, Artificial↗
PubMed1985

Flecainide: electrophysiologic and antiarrhythmic properties in refractory ventricular tachycardia.

Twenty-two patients with coronary artery disease and spontaneous ventricular tachycardia (VT) or ventricular fibrillation (VF) underwent intracardiac electrophysiologic evaluation and, when possible, ambulatory monitoring before and after therapy with flecainide (mean dose 418 +/- 87 mg [mean +/- standard deviation]). An average of 4 antiarrhythmic agents were used and were unsuccessful before therapy with flecainide was begun. During 64 +/- 16 hours of control Holter monitoring in 16 patients, all had 1 or more salvos of VT, as well as ventricular premature complexes (VPCs). Programmed stimulation during the control period induced VT in 17 of 22 patients. After flecainide therapy, Holter monitoring showed elimination of all forms of VT in all but 1 patient, as well as significant reduction of paired VPCs by 95% (p less than 0.03) and single VPCs by 70% (p less than 0.005). Electrophysiologic study during flecainide therapy showed significant increases in AH, HV, PR, QRS and QTc intervals, and the ventricular effective refractory period. Programmed stimulation in 17 patients taking flecainide, with a mean plasma level of 1,075 +/- 521 ng/ml, showed ablation of inducible VT in only 2 patients, a worsening in 5 and continued VT inducibility in 10. Adverse effects that required drug withdrawal were infrequent and encountered in patients who received higher drug levels: 1 patient with congestive heart failure and 1 with severe sinus bradycardia. Thus, although flecainide suppresses complex ventricular arrhythmias on Holter recordings, it rarely alters the response to programmed stimulation. Caution is recommended in its use for recurrent sustained VT or VF and in the interpretation of electrophysiologic studies until the predictive value of programmed stimulation with flecainide therapy is established.

Adult↗
PubMed1985

Results of late programmed electrical stimulation and long-term electrophysiologic effects of amiodarone therapy in patients with refractory ventricular tachycardia.

Thirteen patients with refractory, recurrent, life-threatening ventricular tachycardia (VT) underwent electrophysiologic testing before and after long-term amiodarone therapy. Nine patients (69%) had coronary artery disease, 3 (23%) had nonischemic cardiomyopathy and 1 patient (8%) had mitral valve prolapse. At control electrophysiologic study, programmed electrical stimulation (PES) induced VT in all patients: sustained VT in 11 and nonsustained VT in 2 (9 beats and 31 beats). After oral loading with amiodarone, 1200 mg/day for 14 days, followed by maintenance therapy with 408 +/- 20 mg/day (mean +/- standard error of the mean), repeat PES at 6 +/- 1.6 months revealed inducible VT in 12 of 13 patients: sustained VT in 11 and nonsustained VT (32 beats) in 1 patient. Inducible VT was suppressed in only 1 patient. Amiodarone significantly increased sinus cycle length, PR interval, QRS duration and right ventricular effective refractory period. Insignificant increases in AH, HV and QTc intervals were noted. At 24 +/- 2 months, 8 patients (62%) (all with inducible VT at late PES) were free of clinical arrhythmic events (syncope or sudden death), compared with 5 patients (38%) (4 with inducible VT at late PES) with events. There were no significant differences in the induced VT cycle length, VT cycle length change, ease of inducibility or hemodynamic response to induced VT at late PES in patients with and without arrhythmic events.(ABSTRACT TRUNCATED AT 250 WORDS)

Amiodarone↗
PubMed1985

Management of the prolonged QT syndrome and recurrent ventricular fibrillation with an implantable automatic cardioverter-defibrillator.

Two patients with the prolonged QT syndrome and recurrent ventricular tachyarrhythmias are presented, one of them refractory to combination antiarrhythmic drug therapy and bilateral stellate ganglion blockade. We implanted and tested in vivo an automatic cardioverter-defibrillator to provide a cardiac monitoring system with the capability of delivering a 25 J electrical discharge to the heart if rapid ventricular tachycardia or ventricular fibrillation is detected. Arrhythmia induction in the electrophysiology laboratory confirmed the appropriate recognition of the arrhythmias in each patient, with prompt discharge of the device and resultant termination of the tachycardias. We suggest that implantation of such a device may provide an effective adjunct to antiarrhythmic drug therapy in the management of infrequent, but potentially lethal, ventricular arrhythmias occurring in patients with the prolonged QT syndrome.

Adult↗
PubMed1985

Amiodarone in the treatment of life-threatening ventricular tachycardia: role of Holter monitoring in predicting long-term clinical efficacy.

Forty-two patients with refractory, recurrent life-threatening ventricular tachycardia and spontaneous ventricular tachycardia (greater than or equal to 3 beats, heart rate greater than 100 beats/min) on baseline 24 hour Holter recording were treated with amiodarone. After 1 week of amiodarone therapy and during the follow-up period (22 +/- 11 months, mean +/- SD), patients had serial 24 hour Holter recordings (10.6 +/- 3.8 per patient). Twenty-four hour, 48 hour or 72 hour Holter monitoring was performed during the second week of therapy. Ventricular tachycardia was suppressed on all follow-up serial Holter recordings in 17 patients (40%). Ventricular tachycardia was suppressed in 34 (81%) of 42 patients with 24 hour Holter recordings, 21 (72%) of 29 patients with 48 hour recordings and 20 (69%) of 29 patients with 72 hour recordings during the second week of therapy. At follow-up 24 patients (57%) were free of clinical arrhythmic events (Sustained ventricular tachycardia or sudden death). The sensitivity, specificity, positive and negative predictive values and predictive accuracy of ventricular tachycardia on 24, 48 and 72 hour Holter recordings during the second week of therapy for predicting subsequent events were analyzed. The positive and negative predictive values were 100 and 71% for 24 hour Holter recordings, 88 and 71% for 48 hour recordings and 89 and 75% for 72 hour recordings. Overall predictive accuracy was 76, 76 and 79%, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
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

Evaluation of flecainide acetate in the management of patients at high risk of sudden cardiac death.

The clinical effectiveness of flecainide acetate was evaluated in 36 patients (29 male and 7 female, average age 56 years) in whom therapy with previous antiarrhythmic agents had failed. All patients had documented ventricular tachycardia on Holter electrocardiographic recording and 31 of 36 (86%) had had syncope or required cardiopulmonary resuscitation, or both. Angiographic findings demonstrated significant coronary artery disease in 22 (61%) and primary left ventricular dysfunction in 14 (39%), with a left ventricular ejection of 0.39 +/- 0.4. Patients were treated with an average flecainide dose of 302 +/- 76 mg/day. The follow-up time was 101 +/- 156 days. Thirty-two of 36 patients (89%) had complete elimination of ventricular tachycardia from Holter monitoring and only 2 patients had flecainide discontinued because of noncardiac side effects (numbness, blurred vision and ataxia). However, the drug was subsequently discontinued in 5 patients because of cardiac side effects (proarrhythmic effect in 2, sinus bradycardia in 1, complete atrioventricular block in 1 and new left bundle branch block in 1) and 10 patients died during flecainide therapy (1 with cerebral stroke, 3 with congestive heart failure and 6 with incessant ventricular tachycardia). A comparison of the general cardiac features of those who died with those who did not revealed a significantly lower ejection fraction (0.24 +/- 0.1 vs 0.45 +/- 0.1, p less than 0.05) and a significantly higher flecainide dose (350 +/- 85 versus 276 +/- 59 mg/day, p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1984

Relationship of specific coronary lesions and regional left ventricular dysfunction to prognosis in survivors of sudden cardiac death.

We prospectively evaluated the relationship of specific coronary arterial and left ventricular segments to subsequent clinical outcome in 80 persons who were survivors of sudden cardiac death and had failed conventional antiarrhythmic therapy. There were 68 men and 12 women with an average age of 51 years who were treated with investigational antiarrhythmic agents, rendered asymptomatic, and followed for 16 +/- 14 (SD) months. At the end of the study 48 patients (60%) were alive and asymptomatic while 32 (40%) had experienced either recurrent syncope (five) or sudden cardiac death (27). The independent relationship of clinical and angiographic variables was performed in a univariate fashion using a Kaplan-Meier survival analysis and then multivariate logistic analysis was used to simultaneously consider all clinical and arteriographic variables. The results reconfirmed the importance of ejection fraction and left ventricular filling pressure on outcome. However, coronary arterial and left ventricular segmental analyses provided additional predictive power. Specifically, the survival outcome was found to be inversely related to the degree of proximal left anterior coronary (LAD) arterial narrowing: at 1 year 90% of patients with minimal LAD narrowing were alive/asymptomatic in contrast with 70% who had partial and 40% who had complete proximal LAD obstruction (p less than 0.005). Analysis of the posterobasal left ventricular segment wall motion demonstrated that 100% of patients with minimal dysfunction were alive/asymptomatic at 1 year, whereas only 52% of patients with severe dysfunction were alive (p less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1984

The treatment of malignant ventricular arrhythmias with combined endocardial resection and implantation of the automatic defibrillator: preliminary report.

Fourteen patients with refractory ventricular tachyarrhythmias were treated with combined endocardial resection and implantation of the automatic defibrillator. There were 11 men and 3 women with a mean age of 53 years (range, 41 to 58 years). All patients had coronary artery disease; the mean ejection fraction was 26%, and the mean number of cardiac arrests was 2.6. Programmed electrical stimulation induced sustained ventricular tachycardia in 13 patients and nonsustained ventricular tachycardia in 1. Operative endocardial mapping in the 13 patients with sustained ventricular tachycardia demonstrated a septal focus of early activation in 9 patients and a nonseptal site in 4. Following resection, sustained ventricular tachycardia could not be reinduced. There was 1 operative death. Programmed electrical stimulation performed one month after operation induced ventricular tachycardia in 5 patients, but tachycardia could not be induced in the other 8 survivors. The longest follow-up was 32 months; the average was 17 months. There were 2 late deaths. One patient died of myocardial infarction and 1 of pulmonary edema following a routine cholecystectomy. In another patient, late ventricular tachycardia developed but was automatically terminated by the implanted defibrillator. These results suggest that endocardial resection combined with implantation of the automatic defibrillator may offer the greatest protection yet available to patients with malignant ventricular tachyarrhythmias.

Adult↗
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

Implantable cardioverter-defibrillator: patient selection and implantation protocol.

The experience obtained from the clinical trials with the automatic implantable cardioverter-defibrillator have reemphasized the need for a detailed pathophysiologic evaluation of the patient preoperatively. This evaluation requires careful documentation of the probable cause of the ventricular tachyarrhythmia and evaluation of other surgical needs of the patient, as well as consideration of the interactive effects of pacemakers and concurrent pharmacologic therapy postoperatively.

Adolescent↗
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

Surgical techniques for implanting the automatic implantable defibrillator.

Since February 1980, the automatic defibrillator was implanted in 77 survivors of multiple cardiac arrest. The subxiphoid technique was used in 28 patients and the thoracotomy technique was used in 20 patients with previous cardiac surgery. Median sternotomy was used in 29 patients undergoing open heart procedures as well as defibrillator implantation. While the subxiphoid is the most benign procedure employed, all are safe and well tolerated. The method used is determined by the clinical picture. Survival studies indicate improved survival in this high risk population.

Adolescent↗