Biomedical subjects

P Tilser

Publications and source records attributed to P Tilser.

At least 19 recordsLinked to original sources

PubMed1995

[Importance of programmed ventricular stimulation in the evaluation of proarrhythmic effects of orally administered anti-arrhythmia agents].

The objective of the submitted work was to assess, using programmed stimulation of the cardiac ventricles during antiarrhythmic treatment (amiodarone and propafenon administered orally), the presence of indicators suggesting imminent ventricular ectopic proarrhythmia. The authors included in the group, after elimination of subjects with ECG (Holter monitoring) signs of proarrhythmias 50 patients (43 men, 7 women, 23-78 years, mean age 54.0 +/- 14.2 years), where they used initial programmed stimulation of the ventricles, not sooner than three months after acute cardiac disease. On account of electric instability of the ventricles the authors administered to 39 patients amiodarone by the oral route (200 to 400 mg/day) and to 11 subjects propafenon also by the oral route (900 mg/day). A subsequent programmed stimulation of the ventricles was repeated after amiodarone treatment after an interval of 4-144 weeks and after propafenon treatment after 1-48 weeks. They included among indicators of proarrhythmic action of antiarrhythmics (as compared with the initial examination): induction of diagnostic tachycardia at a lower grade of stimulation or with a smaller number of extrastimuli, the change from non-persisting unimorphous ventricular tachycardia into permanent unimorphous ventricular tachycardia, an increase of the frequency of tachycardia, marked deterioration of the patient's symptoms during tachycardia and the necessity to eliminate tachycardia by an electric discharge (during the initial examination an electric discharge was not used). The authors described in the group on indicator of proarrhythmic effect conditioned by programmed stimulation of the ventricles in 24 patients (48%). In one subject they found simultaneously two indicators in 12 instances (24%) and three indicators in 5 instances (10%).(ABSTRACT TRUNCATED AT 250 WORDS)

Administration, Oral↗

PubMed1995

[Prognostic importance of invasive electrophysiologic findings in the heart].

The objective of the work was the long-term perspective follow-up of subjects with a normal and pathologically delayed intra-, infra-His conduction in the heart based on the electrogram of the bundle of His and subjects with a normal or pathological finding during programmed stimulation of the ventricles, to assess the impact of these findings for the patients' prognosis. The authors included in the group, after elimination of subjects with the syndrome of ventricular preexcitation, 340 patients (243 men, 97 women, 16-81 years, mean age 49 +/- 16) where they made an invasive electrophysiological examination of the heart (electrogram of the bundle of His without cardiac stimulation, during graded and programmed stimulation of the atria, in 206 subjects also programmed stimulation of the ventricles) not before three months after acute cardiac disease. The authors found normal HV intervals or a normal length of H waves in 286 patients and delayed values in 54 patients. They revealed a diagnostic conclusion of programmed ventricular stimulation in 71 subjects and a non-diagnostic conclusion in 135 subjects. All patients were followed up irrespective of implantation of a pacemaker and antiarrhythmic treatment for 6 to 144 months (mean follow-up period 56.1 months). During the mentioned period they described the occurrence of cardiac deaths (deaths from cardiac causes) in 29 subjects with a normal intra-, infra-His conduction (10.1%), in 12 subjects with delayed intra-, infra-His conduction (22.2%), in 7 subjects with undiagnosed programmed ventricular stimulation (5.2%) and in 13 subjects with diagnosed programmed ventricular stimulation (18.3%).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

PubMed1995

[Indirect calorimetry and pulmonary function in chronic pulmonary disease].

Data derived from indirect calorimetry in patients with stable chronic pneumopathies were evaluated together with their pulmonary function data (spirometry, diffusing capacity, blood gases). Their basal metabolic rate was significantly higher (116.1% of the predicted value), this increase being more expressed in the patients with hypoxemia and with more severe obstructive disorder. In chronic obstructive pulmonary disease, the increased energy expenditure in hypoxemia was accompanied with increased lipid oxidation. There also was a correlation between the patients' nutritional status (evaluated by their body mass index) and their pulmonary function. These results confirm the impairment of pulmonary function in malnourished patients.

Basal Metabolism↗

PubMed1992

[Late ventricular potentials--relation to the results of programmed ventricular stimulation, the incidence of ventricular ectopic arrhythmias and left ventricular function].

The authors evaluated the incidence of late ventricular potentials (LVP) in 84 patients (63 men and 21 women) with programmed stimulation of the ventricles. At the same time they described the relationship of the mentioned potentials to the finding of ventricular ectopic arrhythmias during ECG monitoring and left ventricular function (ultrasonographic examination). Non-invasive recording of late ventricular potentials is due to the assessed sensitivity, i.e. 73%, and specificity i.e. 67% (in relation to the results of programmed ventricular stimulation) a useful method for evaluation of the arrhythmogenic substrate of the heart muscle. The authors detected LVP in 35% of 37 subjects without arrhythmias, in 58% of 31 subjects with premature ventricular contractions class 3 to 5 according to Lown and in 60% of 15 subjects with relapsing ventricular tachycardias. LVP are more frequent in patients with impaired left ventricular function. They were recorded during the ejection fraction of the left ventricle beneath 50% in 69% of 16 subjects and in the left ventricular ejection fraction above 50% in 44% of 68 subjects.

Action Potentials↗

PubMed1991

[Significance of invasive electrophysiologic examination in the diagnosis of ventricular tachyarrhythmia in Wolff-Parkinson-White syndrome].

The authors assessed basic clinical and electrophysiological indicators (using invasive electrophysiological examination) in 15 patients (11 men and 4 women) with symptomatic Wolff-Parkinson-White syndrome. In 47% of the examined patients they detected artificial ventricular tachyarrhythmias during programmed ventricular stimulation. They found that there is a risk of the development of spontaneous ventricular tachyarrhythmias under the following conditions: 1. transfer of impulses from the atria with an increased excitability (in two patients), 2. in the ventricular heart muscle (in one patient). In general they proved a high risk (in 20%) in patients with ventricular fibrillations and ventricular tachycardias leading to sudden death.

Adolescent↗

PubMed1991

[Programmed ventricular stimulation in the evaluation of the clinical significance of premature ventricular contractions].

The authors subjected 34 patients (27 men and 7 women) to invasive electrophysiological examination. All patients had early ventricular contractions class 3-5 according to Lown which were recorded during ECG monitoring in bed or by Holter's system. A pathological excitability of the ventricular myocardium was found during programmed stimulation in 29% of the subjects. The excitability of the heart muscle was substantially enhanced by the incidence of ischaemic heart disease and reduced left ventricular function. The decreased frequency and severity of early ventricular contractions during bicycle ergometry, the absence of palpitations and syncopes increases the probability of normal excitability of the ventricular myocardium.

Adolescent↗

PubMed1991

[Arrhythmic syncope and invasive electrophysiologic heart function tests].

The authors submitted to electrophysiological examination a total of 100 patients (66 men and 34 women) with brief disorders of consciousness where they ruled out extracardiac causes of unconsciousness, impaired blood flow through the heart and the syndrome of s-a node dysfunction. Forty-three subjects had severe arrhythmias during ECG monitoring in bed or by Holter's system (20 subjects paroxysms of ventricular tachycardia, 14 subjects ventricular extrasystoles according to Lown class 3-5, six subjects had transient high-grade a-v blocks, three subjects had symptomatic paroxysms of supraventricular tachycardia). In 57 patients ECG monitoring did not reveal ectopic arrhythmias and high-grade a-v blocks. Invasive examination confirmed or diagnosed arrhythmic syncopes in 49% of the entire group of 100 patients. It assessed the arrhythmic cause of syncopes in 33% of 57 subjects without severe arrhythmias and in 70% of 43 subjects with severe arrhythmias detected during ECG monitoring.

Adolescent↗

PubMed1991

[Predictive value of indicators of oxygen supply to tissues in patients with chronic obstructive lung disease].

The authors investigated in a group of 83 patients with chronic obstructive pulmonary disease the prognostic impact of some indicators of pulmonary function, haemodynamics and oxygen transport. They demonstrated that the prognosis is less favourable in patients with a lower one-second vital capacity with a higher median pressure in the pulmonary artery, with a lower oxygen tension in the arterial blood and higher haemoglobin concentration. They did not reveal significant differences between those who died and those who survived for more than five years, after the examination, as regards oxygen supply of tissues, oxygen consumption, coefficient of oxygen extraction and values of oxygen tension in mixed venous blood. Oxygen inhalation led to an increased oxygen supply of tissues and increased oxygen tension in mixed venous blood to normal values in all examined groups. This observation may be one of the explanations of the more favourable prognosis of patients with respiratory insufficiency, associated with chronic pulmonary obstructive disease, who have permanent oxygen therapy during domiciliary care.

Biological Transport↗

PubMed1990

Changes in pulmonary and systemic haemodynamics after the administration of various vasodilators in patients with pulmonary hypertension.

The authors investigated the influence of some vasodilatory drugs on pulmonary and systemic haemodynamic parameters in 69 patients with pulmonary hypertension secondary to chronic obstructive pulmonary disease (with the exception of two patients with diffuse pulmonary fibrosis and one patient with recurrent pulmonary thromboembolism). The investigated vasodilatory drugs were as follows: Dihydralazine Spofa--8 patients, Corinfar--10 patients, Ketanserin--13 patients, Nit-Ret 7 patients, Nitroglycerin Spofa--10 patients, Nitro-Mack--11 patients, Iso-Mack retard--10 patients. The haemodynamic parameters were measured before and at various time intervals after the administration of the vasodilatory agent (Dihydralazine 50 mg perorally--30th and 60th minute, Corinfar--20 mg sublingually--60th minute, and in 7 patients following a 6 months period of 30-60 mg Corinfar daily dose, Ketanserin--10 mg intravenously--10th, 20th and 40th minute, Nit-Ret--2.5 mg perorally--30th and 60th minute, Nitroglycerin Spofa--0.5 mg sublingually--10th and 30th minute, Nitro-Mack--1 mg intravenously--immediately following the end of a slow i. v. infusion for 20 minutes, Iso-Mack retard--20 mg perorally, 60th minute). The blood gases were measured at the same time intervals, too. The results in various groups were as follows: Dihydralazine administration was not followed by any significant change in PAP, CO, PVR, while a significant decrease in AOP and SVR was ascertained. A significant decrease of PaCO2 and no change in PaO2 were measured. Following Corinfar administration, no change in PAP, CO or PVR and a significant decrease of PaCO2 and no change in PaO2 were measured. Following Corinfar administration, no change in PAP, CO or PVR and a significant decrease in AOP were determined. No significant changes in blood gases were measured. Following a 6 month Corinfar treatment period in 7 subjects, no significant changes in pulmonary haemodynamics or blood gases values were found. No clinical benefit of this drug could be estimated. Ketanserin administration was not followed by any changes in pulmonary haemodynamics, whereas a significant decrease in AOP and SVR were found. The administration of Nit-Ret was followed by a significant decrease of CO, whereas no changes in PAP, AOP or PVR and SVR were found. No significant changes in the blood gas tenses values were measured. The administration of Nitroglycerin Spofa was followed by a significant decrease in RAP, PAP, AOP, RVEDP as well as in CO. No significant changes in blood gases were observed. The application of 1 mg Nitro-Mack intravenously was followed by a significant decrease in RAP, PAP, AOP and CO.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗

PubMed1990

[Electrophysiologic effects of orally administered amiodarone].

The authors made an invasive electrophysiological examination of the heart before and after administration of amiodarone by the oral route in 18 patients (15 men and 3 women). Amiodarone was administered in maintenance doses of 200 or 400 mg/day for 3 to 13 months (mean 4.7 months). Comparison of values revealed a significant protraction of R-R, P-Q and QRS intervals on the surface ECG. A-H and H-V intervals on the electrogram of the bundle of His as well as effective refractory periods of the ventricular myocardium were significantly protracted. During high-frequency stimulation of the atria the frequency at which an a-v block grade II type I develops declined. No significant changes developed in Q-Tc intervals on the surface ECG, the PA-A on the electrogram of the bundle of His and in the corrected recovery period of the s-a node.

Administration, Oral↗

PubMed1989

[Monitoring the effectiveness of amiodarone in the treatment of ventricular ectopic arrhythmias].

The authors included in their investigation a total of 18 patients (15 men and 3 women) with electric instability of the ventricular heart muscle during programmed stimulation of the ventricles. They administered amiodarone to the patients by the oral route, 200 or 400 mg per day for a period of 3 to 13 months. They compared the subjective symptomatology, the finding on monitoring of the ECG with the patient in bed or by means of Holter's system and the results of programmed stimulation of the ventricles before and after amiodarone administration. There was a marked decline in the frequency of subjective symptoms reported by the patients (above all syncopes disappeared completely) and there was a marked decline or complete disappearance of serious ventricular ectopic dysrhythmias. Amiodarone eliminated electric instability of the ventricles as proved by programmed stimulation of the ventricles completely in 39% and partly in 11% of the subjects.

Adult↗

PubMed1989

[Relation between the surface ECG and the bundle of His electrogram in 200 patients].

The relationship was assessed between different types of conduction disorders in surface ECG and pathological changes of intervals in electrograms of the His bundle during spontaneous cardiac action and during artificial right atrial stimulation in 200 patients (130 men, 70 women). For the detection of prognostically less favourable intra- and infraHisal conduction disorders it was found important to study the bundle of His electrographically in the following types of surface ECG: complete block of the right Tawara node with left posterior and left anterior hemiblock, complete block of the left Tawara node, left posterior hemiblock, atrio-ventricular block of the 1st degree (particularly when associated with intraventricular conduction disorder), IInd - degree atrio-ventricular block 2:1 (3:1), less so atrio-ventricular block of the IIIrd degree. Even apparently normal surface ECG can sometimes conceal major damage to the His-Purkinje system. Invasive electrophysiological tests are justified by the presence of syncopes or their equivalents due to unknown causes.

Adolescent↗

PubMed1989

[Sensitivity and specificity of programmed stimulation of the cardiac ventricles].

The authors used programmed pacing of the ventricles in a total of 55 subjects (41 men and 14 women). In a group of 36 patients with chronic relapsing ventricular tachycardias they assessed the sensitivity of this method as 83.3%. In 19 subjects without serious organic heart disease and without clinically confirmed tachyarrhythmias programmed pacing of the ventricles did not reveal diagnostic ventricular tachycardias. The specificity of the method was 100%. The highest detection rate of diagnostic ventricular tachycardias was obtained when four extrastimuli were applied during the sinus rhythm and 2-4 extrastimuli, using the basic stimulation rate of 100/min.

Adolescent↗

PubMed1989

[Long-term study of disorders of heart rhythm in patients with chronic diseases of the respiratory system].

The authors investigated the incidence of arrhythmias by the method of continuous recording of ECG tracings according to Holter in 16 patients with chronic respiratory diseases three times in the course of two years. The incidence of arrhythmias was very frequent, more serious disorders (class 3 or a higher class according to Lown's classification) were very rare. The authors provided evidence of a great variability in the incidence of arrhythmias in the same patients during different periods of investigation. They did not reveal a relationship between the incidence of arrhythmias and the degree of functional affection of the lungs, the severity of hypoxaemia and the drop of the maximum aerobic capacity of the lungs. They did not find a relationship between the incidence of arrhythmias and the pressure in the pulmonary artery, or the size of the right or left ventricle or the thickness of their wall. The authors do not consider the finding of arrhythmias in patients with chronic lung disease an unequivocally serious finding, as reported sometimes in the literature.

Adult↗

PubMed1988