Biomedical subjects

N Wasty

Publications and source records attributed to N Wasty.

4 recordsLinked to original sources

PubMed2005

The lack of a simple relation between physician's percutaneous coronary intervention volume and outcomes in the era of coronary stenting: a two-centre experience.

The 2001 ACC/AHA guidelines recommend that percutaneous coronary intervention (PCI) operators perform at least 75 procedures per year to maintain their competency. We performed a post hoc analysis of prospectively gathered PCI data, in the current era of ubiquitous stent use, at two tertiary cardiac care centres. Operators were assigned to a low (<50 cases per year), intermediate (50-74 cases per year) or high volume (>or=75 cases per year) group. Complications evaluated were death, myocardial infarction, coronary perforation, emergent coronary artery bypass surgery and pericardial tamponade. Between 2000 and 2002, 51 operators performed 6,510 PCIs. Stents were used in 79% of cases. Major complications occurred in 0.45% (7/1,572 cases) for the low-volume group, 1.1% in the intermediate-volume group (16/1,438 cases) and 0.86% (30/3,500 cases) for the high-volume group. After adjusting for baseline factors, low- and intermediate-volume operators were not significantly associated with major complications. This study questions the relationship between operator volume and PCI complications in the current era.

Aged↗

PubMed1987

Prospective evaluation of a sequential pacing and high-energy bidirectional shock algorithm for transvenous cardioversion in patients with ventricular tachycardia.

Rapid ventricular pacing alone or in combination with low- or intermediate-energy shocks has limited efficacy in cardioverting rapid ventricular tachycardia (VT) when delivered through two transvenous catheter electrodes. This prospective study determined the efficacy and safety of an algorithm that used a sequence of rapid ventricular pacing (RVP) and intermediate-energy (5 and 15 J) and high-energy (25J) single, bidirectional shocks delivered by two transvenous catheter electrodes in conjunction with a cutaneous electrode in patients with sustained VT. The bidirectional shock was simultaneously delivered over two electrical vectors via a common right ventricular apical cathode and tow anodes consisting of the superior vena caval catheter electrode and cutaneous patch. The electrical therapy delivered was determined by the cycle length of VT. Slow VT (cycle length greater than 300 msec) was sequentially treated by RVP followed by incremental bidirectional shocks of 5, 15, and 25 J. Rapid VT (cycle length less than 300 msec) was treated with no incremental bidirectional shocks of 15 and 25 J. VT was reinduced to determine reproducibility of the algorithm for episodes that were successfully terminated. For patients in whom the primary algorithm failed, a second algorithm was used that excluded 5 and 15 J shocks and went directly to a 25 J shock. VT was reinduced twice and the secondary algorithm was evaluated. Thus, reproducibility of termination of VT with the primary and secondary algorithm was examined. Fifty episodes of slow VT and 40 episodes of rapid VT were induced in 22 patients (mean left ventricular ejection fraction 31 +/- 14%). Six patients had rapid VT, nine patients had slow VT, and seven patients had both.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1986

Long-term efficacy of subendocardial resection in refractory ventricular tachycardia: relationship to site of arrhythmia origin.

Subendocardial resection is performed in patients with ventricular tachycardia (VT), but its efficacy as related to the site of origin of VT is problematic. We analyzed the efficacy of subendocardial resection in 24 patients with coronary artery disease and VT. All patients underwent preoperative and intraoperative mapping before subendocardial resection. Postoperative electrophysiologic studies were performed in the drug-free state 7 to 14 days after subendocardial resection. Group 1 (n = 14) had anterior, septal, or lateral sites of origin, and Group 2 (n = 10) had inferior or posterior sites of origin. Localization of presystolic electrical activity during VT by preoperative and intraoperative mapping was comparable in both groups (100%). Resectability of the site of origin was higher in Group 1. Induction of VT during a postoperative electrophysiological study was higher in Group 2. Perioperative mortality was comparable. Postoperative antiarrhythmic therapy was instituted more frequently in Group 2. Actuarial survival analysis showed improved patient survival at one year after subendocardial resection for both groups. The efficacy of subendocardial resection is related to site of origin of VT: Subendocardial resection is less efficacious in VT with inferior or posterior sites of origin because of nonresectability of the arrhythmogenic area.

Adolescent↗

PubMed1985

Comparative efficacy and safety of oral cibenzoline and quinidine in ventricular arrhythmias: a randomized crossover study.

We compared the clinical efficacy and safety of oral cibenzoline and quinidine in 13 patients with complex ventricular arrhythmias using a randomized, open-label, crossover study. Employing an incremental dose titration protocol, cibenzoline (130 mg twice daily and 160 mg twice daily) and quinidine (300 mg every 6 hours and 400 mg every 6 hours) were administered for 7 days at each dose level, with preceding washout periods. ECG intervals, total number of ventricular premature depolarizations (VPDs), ventricular pairs (VP), and ventricular tachycardia (VT) events were analyzed at control on cibenzoline and on quinidine. Suppression of VPDs was comparable on both drugs (cibenzoline--six patients; quinidine--five patients). Mean serum quinidine concentration was 2.6 +/- 1.2 micrograms/ml, and plasma cibenzoline concentration was 0.48 +/- 0.27 micrograms/ml. Significant clinical and laboratory toxicity was more frequent with quinidine than with cibenzoline (p less than 0.05). Chronic cibenzoline therapy maintained long-term arrhythmia suppression in five of six responders (mean follow-up, 23 +/- 12 weeks). We conclude that cibenzoline and quinidine are equally effective for control of ventricular arrhythmias. Cibenzoline has a more desirable dosing regimen, superior safety profile, and better patient tolerance than quinidine.

Adult↗