Biomedical subjects

P Kertes

Publications and source records attributed to P Kertes.

5 recordsLinked to original sources

PubMed1992

Clinical experience with surgery for paroxysmal supraventricular tachycardia: a report of 103 cases.

One-hundred-and-three patients underwent surgery for paroxysmal supraventricular tachycardia (PSVT). In eighty-three patients (81%), PSVT was due to an accessory atrioventricular pathway (Group I) and in 20 (19%) to Atrioventricular Junctional (AV nodal) Reentrant Tachycardia (AVJRT:Group II). Initial surgery successfully divided 77 of 83 accessory pathways, including 58 of 60 left free wall pathways, 12 of 15 posteroseptal pathways, six of seven right free wall pathways and one anteroseptal pathway. Twenty patients had successful surgery for AVJRT. Surgery was performed with low morbidity and no early or late mortality in either group. One patient in each group required permanent pacemaker implantation. Immediate (within one week) postoperative electrophysiological study using epicardial wires was performed in 96% of patients and repeat electrophysiological study six months later was possible in 65/103 (63%) patients. Patients with surgery for accessory pathways were followed-up for a mean 34 +/- 23 months, while those with surgery for AVJRT for a mean of 13 +/- seven months. No patient with successful surgery has had a clinical recurrence of PSVT. Thus the results indicate that surgery is a safe and curative therapy for patients with PSVT.

Adolescent↗

PubMed1990

Electrical ablation of posteroseptal accessory pathways.

Electrical ablation of a posteroseptal accessory pathway by delivery of direct current electrical energy at the coronary sinus ostium was attempted in six patients. As a result of 12 procedures in these six patients, the posteroseptal accessory pathway was successfully ablated in one patient. Retrograde conduction only was affected in a further three patients, abolishing paroxysmal supraventricular tachycardia in two and reducing the tachycardia rate in one. One of the six patients developed coronary sinus perforation requiring prompt pericardial aspiration. The procedure is complicated, time consuming, of limited efficacy and coronary sinus perforation is a significant risk. Surgery remains the preferred option as a curative procedure for arrhythmias due to posteroseptal accessory pathway.

Adult↗

PubMed1988

The role of permanent pacing after anterior myocardial infarction complicated by transient complete atrioventricular block.

A randomised study was performed to assess the influence of prophylactic permanent pacing on the incidence of late sudden death in patients surviving transient complete atrioventricular block with acute anterior myocardial infarction. Fourteen patients were studied, of whom ten died within two years, confirming the high overall late mortality in this group. The deaths included eight of the nine paced patients, of whom seven died suddenly. We conclude that prophylactic permanent pacing is not warranted in patients surviving transient complete atrioventricular block with acute anterior myocardial infarction.

Adult↗

PubMed1988

The porous titanium steroid eluting electrode: a double blind study assessing the stimulation threshold effects of steroid.

A transvenous pacing lead with a porous electrode which slowly elutes the steroid, dexamethasone sodium phosphate, has been developed. Previous investigations show low and constant stimulation thresholds persisting over at least the first two years post-implantation. As it is not known whether this low threshold results from the steroid or electrode configuration, a double blind study was designed to compare the same electrode configuration with and without steroid over a 2-year follow-up period. There were ten patients in each group with similar age, sex, indications for pacing and implantation data. Regular measurements of postoperative pulse duration thresholds were performed using a customized VVIM pulse generator programmed to 1.5 V output. For the first two days post-implantation, there were no statistical differences in the pulse duration thresholds between the two pacing leads. From 2 weeks to 2 years the pulse duration thresholds for the steroid leads remained almost constant, whereas the leads without steroid showed a typical rise. The difference in pulse duration thresholds between the two groups of leads from two weeks onwards confirmed that it was the steroid rather than the electrode configuration which prevented the rise in chronic stimulation threshold.

Aged↗

PubMed1988

Rate responsive pacing using a minute ventilation sensor.

Minute ventilation, the product of respiratory rate and tidal volume, correlates directly with oxygen consumption, cardiac output, and heart rate. An implantable pacemaker has been developed which allows variation in pacing rate in response to measured changes in minute ventilation. This single chamber system measures transthoracic impedance between the tip electrode of a standard bipolar lead and the pulse generator case. Low amplitude current pulses (1 mA for 15 microseconds) are generated each 50 msec between the the ring electrode and the case. In the adaptive mode, the pulse generator calculates a rate response factor or slope after maximal exercise. This slope, which describes the relationship between pacing rate and minute ventilation together with the pacing rate limits are the only programmable rate responsive features. Minute ventilation rate responsive systems have been implanted in 12 patients (8 females, 4 males), of mean age 63 years. Indications were His bundle ablation (6), acquired complete heart block (4), and sick sinus syndrome (2). At post-implant exercise testing, pacing rate rose within the first minute. Peak rate and time to upper rate were dependent on workload. After exercise, pacing rate remained at peak for up to 2 minutes before a gradual fall to resting rate. Comparative studies of the minute ventilation and the activity sensor pacing systems in the same patients confirmed that the minute ventilation system more closely parallels normal sinus response to activity. The minute ventilation rate responsive pacing system is simple to programme, no special lead is required and the system is highly physiologic.

Aged↗