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Biomedical subjects

M Manz

Publications and source records attributed to M Manz.

At least 127 records · Page 7Linked to original sources
PubMed1987

[Automatic implantable cardioverter-defibrillator (AICD) and antitachycardia pacemaker (Tachylog 651) in the treatment of ventricular tachyarrhythmias].

For the electrotherapy of refractory ventricular tachycardia the automatic implantable cardioverter-defibrillator (AICD) and antitachycardia pacemaker are available. The long-term use of antitachycardia pacing is still limited by the potential risk of acceleration to ventricular fibrillation. To combine the advantages of antitachycardia pacing with back-up defibrillation, we evaluated the use of an antitachycardia pacemaker with the automatic defibrillator. The AICD was implanted in 13 patients with a mean age of 62 years (from 46 to 75 years); six of them with recurrent ventricular tachycardia (170 +/- 16 per minute) which could reliably be terminated by overdrive pacing, received also an antitachycardia pacemaker (Tachylog 651). The underlying cardiac disease was coronary heart disease in 11 patients and cardiomyopathy in 2 cases. All patients had survived 1 to 6 cardiac arrests and had not responded to 6 +/- 1.5 antiarrhythmic drugs. For antitachycardia pacing we used burst stimulation with 4 to 6 stimuli and coupling intervals from 260 to 300 ms. During the follow-up period of 12 +/- 2 months, 83% of 744 tachycardias could be terminated by burst stimulation, according to the diagnostic data of the pulse generator. If the pacemaker failed to terminate or in case of acceleration (three patients), the automatic countershock of the AICD (5-42 per patient) restored sinus rhythm. In seven patients with high rate tachycardia, 2 to 69 AICD discharges occurred. No patient died suddenly, but three died due to underlying disease and one because of a pneumonia postoperatively. Future antitachycardia devices should be flexible with regard to detection and termination modes, combining antitachycardia pacing with back-up defibrillation.

Electric Countershock↗
PubMed1987

[Therapy refractory sinus tachycardia following polytrauma].

The course of a 20-year-old patient with head injury and fractures of the ribs is reported, in whom sinus tachycardia has now persisted for three years. Antiarrhythmic treatment with calcium antagonists, beta-blocking agents and digitalis did not reduce the rate of the tachycardia. Contusio cordis, as well as different mechanisms of arrhythmias after cerebral trauma are discussed.

Adult↗
PubMed1986

[Indoramin in severe cardiac insufficiency. Acute hemodynamic effectiveness].

Systemic peripheral resistance, right and left heart pressures, cardiac output and left ventricular ejection fraction were measured in 12 patients with severe heart failure (stages III-IV of the NYHA), before and after intravenous injection of indoramin (0.2-0.4 mg/kg bodyweight). Peripheral resistance decreased from a mean of 2738.5 to 1294.4 dyn X s X cm-5 (P less than 0.001), mean pulmonary artery pressure from 39.4 to 21.4 mm Hg (P less than 0.001), mean aortic pressure from 105.3 to 86.0 mm Hg (P less than 0.001), left ventricular end-diastolic pressure from 35.3 to 18.3 mm Hg (P less than 0.001), arterio-venous oxygen difference from 36.1 to 25.4% (P less than 0.001), while cardiac output rose from 2.1 to 3.3 l X min-1 X m-2 (P less than 0.001), and the ejection fraction increased from 29.0 to 42.5% (P less than 0.001). Heart rate remained nearly unchanged. There were no significant side effects, such as hypotension or arrhythmias. The results indicate that the parenteral injection of indoramin favourable influences haemodynamic parameters of patients in severe heart failure.

Adult↗
PubMed1986

[Differential analysis of ventricular contraction using digital subtraction angiography].

One hundred and thirty-six patients with various cardiac abnormalities that had been diagnosed by standard methods, were examined by I-V DSA; images of the left and right ventricles during a representative cardiac cycle were submitted to amplitude and phase analysis, using a Fourier transformation. Temporal differentiation of ventricular function was derived from the best available right anterior oblique projection; the amplitude of cardiac movement of abnormal areas in the myocardium were obtained from a grey scale or colour coding at a fixed point. Comparison with a control group of 35 individuals showed the following pathological findings: hypokinetic segments (33 cases) showed delay, dyskinesias (20 cases) showed complete separation of maximal phases, frequently with a double peak in the phase histogram; disturbances of cardiac rhythm (14 cases) showed atypical localisation of initiation of contraction: in Wolfe-Parkinson-White syndrome this is basal-anterior, in left bundle branch block and VVI stimulation it is apical inferior; in hypertrophic obstructive cardiomyopathy (eight cases) it is postero-basal inferior with high, narrow peaks on the phase histogram. Differential phase analysis on I-V DSA enables one to define cardiac contraction in a simple manner.

Angiography↗
PubMed1986

Indoramin in severe congestive heart failure.

The acute and chronic effects of indoramin, a new alpha 1-adrenoceptor antagonist with vasodilating properties, were examined in patients with severe congestive heart failure (New York Heart Association class III or IV). In the acute phase, indoramin, 0.2-0.4 mg/kg body weight, was given intravenously to 12 patients, and systemic peripheral resistance, right and left heart pressures, cardiac output, and left ventricular ejection fraction were determined. After indoramin, hemodynamic parameters improved significantly without heart rate changes. At peak effect (10-20 min), there were significant (p less than 0.001) decreases in mean arterial pressure from 105.3 +/- 20.4 to 86.0 +/- 16.8 mm Hg, mean pulmonary artery pressure from 39.4 +/- 10.4 to 21.4 +/- 5.8 mm Hg, total systemic peripheral resistance from 2,738.5 +/- 660 to 1,294.4 +/- 314 dyn s/cm-5, and left ventricular end-diastolic pressure from 35.3 +/- 6.8 to 18.3 +/- 4.7 mm Hg. There were increases (p less than 0.001) in cardiac index from 2.1 +/- 0.73 to 3.3 +/- 0.88 L/min/m2 of body surface area and in left ventricular ejection fraction from 29.0 +/- 6.4 to 42.5 +/- 4.6%. The arteriovenous oxygen difference fell from 36.1 +/- 6.4 to 25.4 +/- 3.8% (p less than 0.001); heart rate did not change significantly (73.3 +/- 5.4 beats/min control; 76.3 +/- 7.9 beats/min after indoramin). Eight patients were studied in the chronic phase. There were no significant changes in systolic or diastolic blood pressure and heart rate in the supine or upright position.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1986

Current concepts in the treatment of cardiac arrhythmias.

Attention has been paid to the recognition of patients at risk of sudden cardiac death. Whereas the long-term prognosis of healthy subjects with frequent and complex ventricular premature complexes is similar to that of the normal population, coronary patients with frequent and complex ectopy are at high risk of sudden cardiac death; in this group, recent myocardial infarction and impaired left ventricular function increase the likelihood for sudden death. In a similar way, patients with idiopathic dilated cardiomyopathy and reduced left ventricular function, in whom frequent episodes of ventricular tachycardias or ventricular pairs are detected, are at high risk of sudden death. These patient groups with left ventricular impairment may potentially be treated with the alpha 1-antagonist indoramin, which has exhibited antiarrhythmic properties in animal experiments. In a therapeutic dose, indoramin prohibited reflex tachycardia but did not show any additional electrophysiologic effects. Therefore, no adverse effects on sinus node function or on atrioventricular conduction, or intraventricular conduction must be expected during therapy with indoramin.

Adolescent↗
PubMed1986

Combination of antitachycardia pacemaker and automatic implantable cardioverter/defibrillator for ventricular tachycardia.

Antitachycardia pacing for ventricular tachycardia (VT) is associated with the possibility of fibrillating the heart; on the other hand, the frequency of VT and patient discomfort can limit treatment with the automatic implantable cardioverter/defibrillator (AICD). To contribute to the further development of a universal pacemaker, we evaluated the combined use of the antitachycardia pacemaker ("tachylog") and the AICD in five patients with recurrent VT. In the automatic mode, the "tachylog" worked as a bipolar VVI pacemaker. For antitachycardia pacing, a burst of rapid ventricular pacing was delivered at about 80% of the cycle length. During a follow-up period of 5 +/- 2 months (range, 3 to 8) two to 291 successful interventions of antitachycardia pacing were counted from diagnostic data which had been collected by the pulse generator during the course of treatment. When the antitachycardia pacemaker failed to terminate VT, the AICD was activated. In the individual case, between 0 and 41 discharges of the AICD were delivered. The high pulse energy of the AICD did not damage the antitachycardia pacemaker; no interference of the two devices was observed. Future antitachycardia systems should be more flexible with regard to detection and termination modes, combining antitachycardia pacing with back-up defibrillation.

Aged↗
PubMed1986

Automatic implantable cardioverter/defibrillator (AICD) and antitachycardia pacemaker (Tachylog): combined use in ventricular tachyarrhythmias.

UNLABELLED: Antitachycardia pacing in ventricular tachyarrhythmias (VT) is associated with potential acceleration of VT; frequency of VT and discomfort of the patient (pt) can limit treatment with the AICD. We therefore evaluated the combined use of antitachycardia pacing and AICD in 6 of 14 patients (age 50-70, mean 60 years) with AICD implantation because of VT, which could be terminated by temporary overdrive pacing. With the interactive mode of the Tachylog, termination of VT by the pacemaker as well as by the AICD was assessed after implantation. In the automatic mode, the Tachylog functioned as a bipolar VVI device with antitachycardia burst stimulation: 2-5 stimuli, interval 260-300 ms, 1-2 interventions. During follow-up of 12 +/- 5 months, the Tachylog terminated VT reliably 20 to 327 times per patient. In three patients, burst stimulation accelerated VT, which was terminated then by the AICD discharge. CONCLUSION: Drug resistant ventricular tachyarrhythmias can be terminated by the Tachylog pacemaker avoiding patients' discomfort. In case of acceleration, ventricular tachyarrhythmias can be controlled by the automatic implantable cardioverter/defibrillator. A universal pacemaker should combine antitachycardia pacing with back-up defibrillation mode.

Aged↗
PubMed1986

[Antitachycardia pacing therapy in supraventricular tachycardia using the microcomputer-guided Tachylog 651 pacemaker].

Microprocessor-controlled antitachycardia pacemaker expand the automatic detection of the tachycardia and incorporate multiple, different termination modes. We report our results in the long-term therapy of paroxysmal supraventricular tachycardia with the antitachycardia pacemaker "Tachylog 651". The system was implanted in 10 patients with a mean age of 48 years (from 20 to 68 years): Wolff-Parkinson-White syndrome 4 patients, paroxysmal AV nodal reentrant tachycardia 6 cases. The rate of the reentrant tachycardia was 162 +/- 23/min. The system reliably differentiated between paroxysmal supraventricular tachycardia and sinus tachycardia, including 4 patients with a tachycardia rate of less than 150/min. Burst overdrive pacing was effective in 6 patients and the "self-search system" in 3 patients. During follow-up of 9 +/- 4 months 104 +/- 93 successful interventions per patient were observed; change of the termination mode became necessary in 4 patients and of the detection mode in 3 patients. The incorporation of programmable detection and multiple termination modes in the microprocessor-controlled antitachycardia systems allows the effective long-term antitachycardia pacing. The multiprogrammable "Tachylog 651" pacemaker is an advancement in the electrotherapeutic treatment of paroxysmal supraventricular tachycardias, including the automatic treatment of tachycardias with low rates.

Adult↗
PubMed1986

[Nodofascicular fibers (Mahaim) as a part of the reentry circuit in patients with supraventricular tachycardia].

A history of paroxysmal tachycardia with broad QRS complexes resembling left bundle branch block led to electrophysiologic studies in a 20-year-old female. The results were diagnostic of a nodofascicular Mahaim fiber. Delayed retrograde conduction following transient proximal right bundle branch block as well as an infranodal termination mode were noted and are considered to be proof of participation of the nodofascicular fibers in the re-entry loop. Marked differences of atrioventricular conduction were noted on comparing refractory period determinations from the right atrium and from the coronary sinus. These observations are consistent with partial supranodal bypass of the N zone of the AV node and preferential depolarisation of the Mahaim fiber via the superficial (anterior) nodal approaches. The report provides an example of a nodofascicular fiber being the only connection of an alternative nodal pathway to the ventricles, thus providing a basis for junctional re-entry. Furthermore our data allow an analysis of the different characteristics of intranodal conduction to the His bundle versus to the nodofascicular fibers.

Adult↗
PubMed1986

[Electrophysiologic effects of diprafenone in supraventricular and ventricular tachycardia].

The electrophysiologic effects of diprafenone were evaluated in 31 patients (9 X AV nodal reentrant tachycardia, 9 X Wolff-Parkinson-White syndrome, 4 X paroxysmal atrial fibrillation, 10 X recurrent ventricular tachycardia). Electrophysiologic studies were performed before and after intravenous infusion of 1.5 mg/kg body weight diprafenone in a period of 10 minutes. Diprafenone prolonged the mean RR interval during sinus rhythm from 690 +/- 109 ms to 789 +/- 93 ms and the maximal sinus node recovery time from 1081 +/- 216 ms to 1300 +/- 398 ms (p less than 0.001). The effective refractory period of the right atrium increased from 195 +/- 22 ms to 210 +/- 28 ms (p less than 0.01) and of the right ventricle from 220 +/- 20 ms to 235 +/- 20 ms (p less than 0.001). Diprafenone produced a prolongation of the antegrade effective refractory period of the AV node from 260 +/- 35 ms to 294 +/- 39 ms (p less than 0.01) and of the retrograde effective refractory period from 265 +/- 76 ms to 400 +/- 130 ms (p less than 0.001). The effective refractory periods of the Kent bundle increased: antegrade from 299 +/- 45 ms to 413 +/- 133 ms, retrograde from 252 +/- 33 ms to 286 +/- 169 ms (p less than 0.05). Suppression of inducibility was observed in 12 of 17 patients with supraventricular reentrant tachycardia, in 5 of 8 patients with atrial fibrillation and in 7 of 10 patients with recurrent ventricular tachycardia. The rate of supraventricular tachycardias decreased under the influence of the substance.(ABSTRACT TRUNCATED AT 250 WORDS)

Anti-Arrhythmia Agents↗
PubMed1985

Usefulness of programmed stimulation in predicting efficacy of propafenone in long-term antiarrhythmic therapy for paroxysmal supraventricular tachycardia.

The electrophysiologic effects of intravenous (i.v.) and oral propafenone were evaluated in 14 patients with Wolff-Parkinson-White syndrome and in 10 patients with atrioventricular (AV) nodal reentrant tachycardia. The effective refractory periods of the right atrium and the AV node increased after both preparations. In patients with Wolff-Parkinson-White syndrome, i.v. propafenone blocked anterograde accessory pathway conduction in 2 patients and retrograde conduction in 1; during oral therapy, accessory pathway conduction block occurred in 2 additional patients. The mean cycle length of the supraventricular tachycardia (SVT) increased from 338 +/- 60 ms to 387 +/- 56 ms (p less than 0.05) after i.v. application, and from 336 +/- 65 ms to 367 +/- 65 ms (p less than 0.05) during oral propafenone. The shortest pacing interval maintaining a 1:1 AV conduction increased from 325 +/- 65 ms to 368 +/- 81 ms (p less than 0.05) after i.v. infusion, and from 333 +/- 57 ms to 369 +/- 75 ms (p less than 0.05) during oral therapy. There was no difference in the electrophysiologic effects between i.v. and oral propafenone. The induction of SVT was prevented by i.v. propafenone in 10 of 20 patients and in 4 additional patients with oral propafenone. During follow-up, 6 of 7 patients, whose SVT could not be initiated by electrophysiologic drug testing, remained free from recurrences, whereas 5 of 7 patients with inducible tachycardia had recurrences of SVT. Thus, in patients with SVT, propafenone prolonged accessory pathway and AV nodal conduction and had a beneficial effect on circus movement tachycardia.(ABSTRACT TRUNCATED AT 250 WORDS)

Administration, Oral↗
PubMed1985

[Supraventricular tachycardia: the results of bundle of His ablation].

Transvenous electrical ablation of AV conduction was performed in 15 patients with drug-resistant supraventricular tachycardia. Eight patients had paroxysmal AV nodal reentry tachycardia, one had permanent junctional reentry tachycardia, five had recurrent atrial flutter and one paroxysmal atrial tachycardia. The intracardiac ablation was done with 150-350 J, on average twice per patient. Permanent 3 degrees AV block was achieved in ten patients, in none of whom there was a recurrence of the tachycardia. In four patients with re-established AV conduction the clinical symptoms had nonetheless improved; despite repeated use of His-bundle ablation, permanent junctional reentry tachycardia could not be controlled satisfactorily and required surgical section of the accessory pathway. Apart from septic fever in one patient there were no serious complications. Implantation of a pacemaker, however, was required in all those patients in whom a permanent 3 degrees AV block had been produced. For this reason alone, His-bundle ablation should only be used in drug-refractory supraventricular tachycardias. But in these this method presents an important advance in treatment.

Adolescent↗
PubMed1985

[Localization of pre-excitation in the WPW syndrome by analysis of the ventricular contraction course].

Fourier phase analysis of gated radionuclide ventriculography (RNV) was applied in 23 patient for the identification of cardiac contraction patterns in WPW syndrome (controls with normal ventricular function and sinus rhythm, n = 30). The sequence and velocity of regional ventricular wall motion was determined and correlated to the results of electrophysiological studies. In 3/23 patients the contraction pattern was not different from controls. Indicating the preexcitation in 20/23 patients the earliest ventricular contraction was localized as follows: right atrial n = 5, paraseptal right n = 2, paraseptal left n = 6 and atrial left n = 7. In 15/16 patients nuclear data corresponded with electrophysiological endocardial mapping. Phase analysis of RNV provides a reliable non-invasive method for localization of preexcitation in WPW syndrome.

Electrocardiography↗
PubMed1985

[Sotalol in supraventricular tachycardia. Electrophysiologic measurements in Wolff-Parkinson-White syndrome and AV node re-entry tachycardia].

The electrophysiologic effects of sotalol were studied in 11 patients with Wolff-Parkinson-White syndrome and 9 patients with AV nodal reentrant tachycardia. Electrophysiologic studies were performed before and after intravenous infusion of 80 mg sotalol over a period of 5 minutes. Sotalol prolonged the effective refractory period of the right atrium and the right ventricle. Both AV node and accessory pathway conduction were depressed by sotalol in antegrade and retrograde directions. Induction of reentrant tachycardia was prevented in 6 of 18 patients. The rate of reentrant tachycardia decreased from 182 +/- 29/min to 153 +/- 14/min (p less than 0.01) and the ventricular rate during atrial fibrillation from 148 +/- 14/min to 112 +/- 12/min (p less than 0.05). Sotalol exhibited a depressant effect on all parts of the reentrant circuit: atrium, ventricle, AV node, and accessory pathway. Thus, sotalol is effective in the therapy of patients with recurrent supraventricular tachycardias.

Adult↗