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Osmund Bertel

Publications and source records attributed to Osmund Bertel.

15 recordsLinked to original sources
PubMed2005

Ibutilide in persistent atrial fibrillation refractory to conventional cardioversion methods.

BACKGROUND: Electrical cardioversion of atrial fibrillation seems to be enhanced by pretreatment with ibutilide, but only few is known about the effects of ibutilide in atrial fibrillation which failed to convert with class III antiarrhythmic agents and electrical cardioversion. The objectives of this study were to evaluate the efficacy and safety of ibutilide administration in patients with persistent atrial fibrillation refractory to long-term therapy with class III antiarrhythmic drugs and transthoracic cardioversion. METHODS: Prospective study in 22 patients (16 men and 6 women, mean age 63+/-9 years) with structural heart disease and persistent atrial fibrillation for a mean duration of 39+/-50 (range 1-145) months. All patients had failed to convert to sinus rhythm after transthoracic cardioversion while on treatment with class III antiarrhythmic drugs (amiodarone in 82%, sotalol in 18%). One milligram of ibutilide was administered in all patients and electrical cardioversion was performed again, if necessary. RESULTS: The total conversion rate to sinus rhythm was 95% (21 of 22 patients). Two patients (9%) were successfully converted after ibutilide alone and 19 patients (86%) when transthoracic cardioversion was repeated after ibutilide. The QTc intervals increased from 451+/-28 to 491+/-49 ms (p<0.001) after ibutilide. No adverse effects occurred. The rate of freedom from atrial fibrillation after 1 month of follow-up was 64%. CONCLUSIONS: The efficacy of concomitant use of ibutilide infusion and, if necessary, repeated transthoracic cardioversion for restoration of sinus rhythm in long-term persistent atrial fibrillation and previously failed antiarrhythmic and electrical cardioversion was 95%. There were no adverse effects associated with ibutilde administration. Our results suggest that this combined strategy may be safe and successful in patients with atrial fibrillation resistant to conventional cardioversion methods and may be an alternative to internal cardioversion.

Anti-Arrhythmia Agents↗
PubMed2004

Intravenous thrombolysis for acute ischaemic stroke in a hospital without a specialised neuro-intensive care unit.

BACKGROUND: Treatment with intravenous (i.v.) recombinant tissue plasminogen activator (rt-PA) is recommended for selected patients with acute ischaemic stroke. We evaluated the feasibility and safety of this treatment in clinical practice in a hospital without a specialised neuro-intensive care unit. METHODS: We prospectively studied all patients who were treated with i.v. rt-PA for ischaemic stroke at our hospital between January 2001 and June 2002. The selection criteria corresponded to those published by the NINDS [1] and ECASS [2] groups. Time intervals between stroke symptom onset, hospital arrival and treatment with rt-PA were measured. A modified NIH stroke scale was used to assess clinical outcome 24 hours after stroke onset and before discharge. Cerebral computed tomography was performed prior to thrombolysis and again if the neurological status failed to improve or deteriorated. RESULTS: Thrombolytic therapy was administered to 15 acute ischaemic stroke patients, 13 men and two women with a median age of 69 years. The median time from stroke onset to rt-PA therapy was 135 minutes and from arrival in the emergency room to the start of thrombolysis 74 minutes. Ten patients exhibited early clinical improvement, defined as a decrease in NIHSS score by 4 points at 24 hours. Further improvement until discharge was observed in nine of these ten patients. One patient developed a non-fatal intracerebral haemorrhage. Another patient with severe stroke and clinical failure of thrombolysis died after 25 days. CONCLUSIONS: This study in a small patient population suggests that thrombolysis with rt-PA for acute ischaemic stroke is feasible without excess risk in a hospital experienced in the management of stroke patients, with a neurological consultant service but without a specialised neuro-intensive care unit (NICU). The outcome in this small series of patients corresponds to the results described in the randomised trials.

Aged↗
PubMed2004

Prevention of atrial fibrillation after cardiac valvular surgery by epicardial, biatrial synchronous pacing.

OBJECTIVE: Postoperative atrial fibrillation (AF) after cardiac surgery is a frequent complication after valvular surgery (30-60%). The purpose of this prospective, randomized study was to determine if biatrial synchronous pacing reduces postoperative AF after cardiac valvular surgery as compared to conventional therapy. METHODS: Eighty patients subjected to valvular surgery (52 men, age 66 +/- 10 years) were randomized to one of two groups: one group was treated with biatrial, synchronous pacing (BAP) for 72 h postoperatively (n=40) the other group received no atrial pacing (controls; n=40). All patients had one pair of epicardial wires attached to the right atrium. An additional electrode was placed to the left atrium in the BAP group. These patients were continuously paced at a rate of 10 beats per minute higher than the intrinsic rate starting immediately after surgery. All patients were monitored with full disclosure telemetry or Holter monitors to identify onset of AF. RESULTS: Eighteen of the 40 patients in the control group (45%) developed AF within the first 3 days postoperatively as compared to eight patients (20%) in the BAP group (P=0.02). No complications occurred associated with the placement, maintenance and removal of the atrial pacing electrodes. CONCLUSIONS: Temporary, biatrial synchronous pacing during the first 3 postoperative days is safe and has a significant rhythm-stabilizing effect in patients undergoing valvular cardiac surgery.

Aged↗
PubMed2003

Troponin as a risk factor for mortality in critically ill patients without acute coronary syndromes.

OBJECTIVES: We sought to assess the mechanism and prognostic value of elevated troponins in patients without acute coronary syndromes (ACS). BACKGROUND: Cardiac troponins are used as specific markers for the diagnosis of ACS. Recent studies reported a considerable number of critically ill patients without ACS as being troponin-positive, especially patients with sepsis, pulmonary embolism, renal failure, and stroke. METHODS: We analyzed 58 consecutive, critically ill patients admitted for reasons other than ACS, according to their troponin status. Thirty-day mortality, left ventricular ejection fraction (LVEF), and a panel of inflammatory cytokines were compared between troponin-positive and troponin-negative patients. Relevant coronary artery disease was excluded either by stress echocardiography or autopsy. RESULTS: Of the 58 critically ill patients, 32 (55%) without evidence of ACS were troponin-positive. Positive troponin levels were associated with higher mortality (22.4% vs. 5.2%, p < 0.018) and a lower LVEF (p = 0.0006). Troponin-positive patients had significantly higher median levels of tumor necrosis factor (TNF)-alpha, its soluble receptor, and interleukin (IL)-6. A subgroup of 10 aplastic patients was troponin-negative at study entry. Three became troponin-positive during leukocyte recovery and subsequently died, whereas all the others stayed troponin-negative and survived. Flow-limiting coronary artery disease was not demonstrable at autopsy or stress echocardiography in 72% of troponin-positive patients. CONCLUSIONS: Elevated troponin is a mortality risk factor for medical intensive care patients admitted for reasons other than ACS. It is associated with decreased left ventricular function and higher levels of TNF-alpha and IL-6.

Acute Disease↗
PubMed2003

Insufficient awareness of endocarditis prophylaxis in patients at risk.

OBJECTIVE: To determine whether patients at risk for development of infective endocarditis (IE) have adequate knowledge of IE and the need for endocarditis prophylaxis (EP), and to test the impact of reeducation on subsequent knowledge. METHODS: We assessed awareness of IE and EP in 139 patients at risk. To assess their knowledge of IE and EP, patients were asked to complete a questionnaire. 59 patients underwent education concerning IE and EP. RESULTS: On the basis of 123 analysed questionnaires, 87 patients were considered high risk and 36 moderate/low risk. Overall, 59% displayed inappropriate knowledge of IE and EP, 15% did not remember receiving IE education, nor had they been given an EP card. The term "endocarditis" was correctly defined by 45%. 63% were aware of the precautions necessary for IE and 55% remembered the need for antibiotic prophylaxis prior to invasive dental procedures. More than two thirds of the patients with prior education and an EP card could not recall having their knowledge of IE and EP "brushed up" by their primary care physicians. Only 21% had not informed their dentist of their risk for IE. CONCLUSIONS: Many patients at risk for IE have an inadequate knowledge of their heart disease, IE, and EP. Most of them are unaware of the need for good dental hygiene. Educational efforts should be intensified and regularly upgraded in adults with valvular disease. Communication between patient, physician and dentist needs to be improved in order to address these issues.

Adult↗
PubMed2003

Diagnostic yield of automatic and patient-triggered ambulatory cardiac event recording in the evaluation of patients with palpitations, dizziness, or syncope.

BACKGROUND: Recent studies have shown that patient-triggered cardiac event recorders (CER) have an increased diagnostic yield and are more cost effective than conventional 24-h-Holter electrocardiograms (ECGs) for the evaluation of sporadic, potentially arrhythmia-related symptoms. HYPOTHESIS: The aim of this study was to determine the diagnostic yield of a patient-triggered CER combined with continuous automatic arrhythmia detection in the evaluation of sporadic dizziness/syncope or palpitations and its clinical relevance in assessing the further management. METHODS: We investigated 101 consecutive outpatients (54 +/- 20 years, 40 women), referred for evaluation of sporadic dizziness and syncope (36%) or palpitations (64%) of suspected rhythmogenic origin. All were monitored by patient-triggered CER with continuous automatic arrhythmia detection. RESULTS: After a mean monitoring period of 103 +/- 38 h, 83 patients registered symptoms and 57 patients had diagnostic or therapeutic relevant arrhythmias (relA). A total of 196 episodes of relA were recorded; 31 (16%) episodes were patient-triggered and 165 (84%) automatically recorded. Diagnostic relevant episodes (relA and/or typical symptoms) occurred in 94 patients, in 54% after the first 24 h of monitoring. According to the results of the CER, 80 patients needed no further diagnostic evaluation; 20 had additional diagnostic tests. CONCLUSIONS: Cardiac event recorders with a continuous automatic arrhythmia detection function are a well-tolerated device for sporadic, potentially arrhythmia-related symptoms. The patient-triggered mode alone is not sufficiently reliable; the automatic continuous arrhythmia detection function has additional diagnostic and therapeutic consequences. In 54% of all patients, the first diagnostic event would not have been recorded with a single conventional 24-h-Holter ECG.

Arrhythmias, Cardiac↗
PubMed2003

Characteristics of patients with abnormal stress technetium Tc 99m sestamibi SPECT studies without significant coronary artery diameter stenoses.

BACKGROUND: Single-photon emission computed tomography (SPECT) sestamibi (MIBI) is an excellent tool for detection of coronary artery disease (CAD), preoperative risk assessment, and follow-up management after coronary revascularization. While the sensitivity of MIBI SPECT for detecting CAD has been reported to exceed 90%, the specificity ranges between 53-100%. HYPOTHESIS: The study was undertaken to assess characteristics of patients with abnormal stress technetium Tc99m sestamibi SPECT (MIBI) studies without significant coronary artery diameter stenoses (< 50%). METHODS: Between January 1999 and November 2000, 270 consecutive patients were referred for coronary angiography due to reversible MIBI uptake defects during exercise. In 41 patients (15%; 39% women, mean age 59 +/- 9 years), reversible MIBI uptake defects were assessed although coronary angiography showed no significant CAD. These patients were compared with age- and gender-matched patients with perfusion abnormalities (39% women, mean age 60 +/- 9 years), due to significant CAD (coronary artery stenosis > 50%). RESULTS: There were no significant differences between the two groups regarding body mass index, left bundle-branch block (LBBB), or method of stress test (dipyridamole in patients with LBBB or physical inactivity [n = 11] and exercise in all the others [n = 30]). Left ventricular hypertrophy (44 vs. 23%, p = 0.05) and left anterior fascicular block (LAFB) (17 vs. 0%, p = 0.005) were more common in patients with perfusion abnormalities with no significant CAD, whereas ST-segment depression during exercise (17 vs. 37% p = 0.05) and angina during exercise (15 vs. 29%, p = 0.02) were significantly less common than in patients with abnormal MIBI perfusion studies and angiographically significant CAD. Sestamibi uptake defects during exercise were significantly smaller in patients without significant CAD than in matched controls with significant CAD (p < 0.0004). CONCLUSION: Of 270 consecutive patients, 41 (15%) referred to coronary angiography due to reversible MIBI uptake defects showed coronary artery stenoses < 50%. Twenty-six (10%) of these presented angiographically normal coronary arteries. The significantly higher proportion of left ventricular hypertrophy and LAFB in patients with reversible MIBI uptake defects without significant CAD suggest microvascular disease, angiographically underestimated CAD, and conduction abnormalities as underlying mechanisms.

Aged↗
PubMed2003

Long-term outcome of acute myocarditis is independent of cardiac enzyme release.

BACKGROUND: There are few data concerning prognostic markers of acute myocarditis. The purpose of this study was to assess the prognostic value of initial measurements of creatine kinase (CK), cardiac troponin I (cTnI) and myoglobin as regards late recovery of the left ventricular ejection fraction on follow-up. METHODS: A total of 22 patients (53+/-15 years old, 11 female) with acute myocarditis were followed up in a prospective observational study. Of these, 11 (50%) showed a history of acute infection prior to hospitalisation and seven (32%) had pericardial effusion. The median ejection fraction during the acute phase was 47+/-17%; after a mean follow-up of 119+/-163 days it improved to 60+/-9% (P<0.001). Considering maximal CK-rise values of 641+/-961 U/l (P=0.38), cTnI-rise values of 3.7+/-8.6 microg/l (P=0.16) and myoglobin values of 7.4+/-12 nmol/l (P=0.69), there was no correlation between initial cardiac enzyme levels and the initial and late left ventricular ejection fraction. CONCLUSION: After acute myocarditis, there is late recovery of left ventricular ejection fraction, which is independent of the initial myocardial damage measured by cardiac enzyme release.

Acute Disease↗
PubMed2002

Long-term results after acute percutaneous transluminal coronary angioplasty in acute myocardial infarction and cardiogenic shock.

The aim of this study was to determine the long-term outcome in unselected, consecutive patients after acute percutaneous transluminal angioplasty (PTCA) for acute myocardial infarction (AMI) complicated by cardiogenic shock. This involved a follow-up study from a prospectively conducted patient registry in a tertiary referral center. A total of 59 patients (10 female/49 male; median age 62 years (32-91)) with percutaneous transluminal cardiac interventions in primary cardiogenic shock were identified between January 1995 and January 2000. Twenty-two patients (37%) had been resuscitated successfully before intervention. The in-hospital mortality of shock patients was 36% (n=21, median age 68 (47-84)). The median follow-up of survivors was 18.1 (7-57.3) months, during which three further patients died (8%; two because of sudden cardiac deaths, one because of acute reinfarction). Achievement of thrombolysis in myocardial infarction (TIMI) flow III after acute PTCA (84% in survivors vs. 38% in non-survivors; P<0.001) and the absence of the left main coronary artery (3% survivors vs. 29% non-survivors; P=0.003) as culprit lesion in patients with cardiogenic shock was strongly associated with an improved survival rate. A second cardiac intervention was performed in seven patients (18%). Overall functional capacity of shock survivors was good. At final follow-up, 80% of the survivors were completely asymptomatic. One patient had angina pectoris NYHA II, five patients dyspnoea NYHA class II. Exercise stress-test was performed in 24 of the 38 surviving patients, median exercise capacity was 100% (range 55-113%) of the age adjusted predicted value. In unselected patients with cardiogenic shock due to AMI, treatment with acute PTCA resulted in an in-hospital mortality of 36%, low late mortality and good functional capacity in long-term survivors. TIMI flow grade III after acute PTCA in patients with acute myocardial infarction complicated by cardiogenic shock was strongly associated with an improved survival rate whereas the left main coronary artery as culprit lesion was associated with worse outcome.

Adult↗
PubMed2002

Interaction of sildenafil with cAMP-mediated vasodilation in vivo.

Sildenafil inhibits cGMP breakdown by phosphodiesterase 5. In vitro, increased cGMP levels inhibit cAMP breakdown by phosphodiesterase 3. It is uncertain, however, whether sildenafil increases biological effects of interventions increasing cAMP levels in vivo. The objective of the present study in 40 healthy male volunteers was to determine the existence and extent of interactions with sildenafil and vasodilators acting via cGMP or cAMP or independently from these mediators on the arterial tone of the human forearm. Forearm blood flow (FBF) responses (plethysmography) to brachial artery infusions of 3 doses each of nitroglycerin, which increases cGMP levels; of isoprenaline and milrinone, which increase cAMP levels; and of verapamil as a control were assessed at baseline and 80 minutes after 50 mg oral sildenafil in 10 volunteers each. Sildenafil increased FBF (2.5+/-0.1 to 3.5+/-0.2 mL/min per 100 mL, P<0.001; n=40). At equipotent vasodilator dosages, sildenafil increased FBF from 7.5+/-1.0 to 9.8+/-1.2 mL/min per 100 mL for nitroglycerin, from 8.3+/-1.0 to 10.4+/-1.4 mL/min per 100 mL for isoprenaline, and from 8.1+/-1.0 to 10.3+/-1.2 mL/min per 100 mL for milrinone and slightly decreased FBF from 7.7+/-1.3 to 7.1+/-1.2 mL/min per 100 mL for verapamil. ANOVA for repeated measures revealed a significant interaction between sildenafil and the type of vasodilator on FBF (P<0.01). The responses of FBF to nitroglycerin, milrinone, and isoprenaline after sildenafil were similarly increased compared with the response to verapamil (P<0.01). Sildenafil markedly enhanced the arterial vasodilator response to nitroglycerin, milrinone, and isoprenaline. The response to milrinone and isoprenaline is compatible with an interaction between cGMP and phosphodiesterase 3 or an enhancement of the NO component of cAMP-mediated vasodilation, and raises the possibility of enhanced biological effects of interventions leading to increases of cAMP in the presence of sildenafil.

Adrenergic beta-Agonists↗
PubMedDate not supplied

Assessment of indications in interventional cardiology: appropriateness and necessity of coronary angiography and revascularization.

In this study we present appropriateness and necessity assessments of coronary angiographies and revascularizations to determine adherence to Swiss guidelines by using the computerized second-opinion system (SOS) as a reference. We prospectively compared SOS ratings with ratings of treating cardiologists and surgeons for 203 coronary angiographies and 100 percutaneous transluminal coronary angioplasties. We also retrospectively assessed indications of 103 coronary artery bypass grafts. SOS ratings of appropriate, uncertain, and inappropriate indications for coronary angiography were 85.5%, 10%, and 4.5%, respectively, and 99.5%, 0.5%, and 0%, respectively, for revascularization. Corresponding clinicians' ratings were 95%, 4%, and 1% and 100%, 0%, and 0%, respectively. SOS ratings of necessary, uncertain, and unnecessary indications for angiography were 82.4%, 17.6%, and 0%, respectively, and 97%, 3%, and 0%, respectively, for revascularization. Corresponding clinicians' values were 88.2%, 10.6%, and 1.2% and 98%, 2%, and 0%, respectively. Significant statistical differences for coronary angiography were found for patients with acute myocardial infarction and for patients within 12 weeks of myocardial infarction. A high accordance between estimated SOS and clinically estimated appropriateness of procedures was found, which might suggest that the guidelines are valid. Regular validation and updating of the guidelines is highlighted. Possible overuse of angiography in patients within 12 weeks of myocardial infarction may need further investigation.

Adult↗