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Biomedical subjects

R N Scott Millar

Publications and source records attributed to R N Scott Millar.

9 recordsLinked to original sources
PubMed2003

Utilization of implantable defibrillators in Africa.

Sub-Saharan Africa is dominated by diseases of poverty. HIV/AIDS affects 28.5 out of a total of 600 million in the region. South Africa is the only country in sub-Saharan Africa in which implantable cardiovertor defibrillators (ICDs) are implanted (0.8/million in 2001). Only 3 of the 35 new ICDs were implanted in state-funded public hospitals. The pacemaker implantation rate for South Africa was 41/million in 2001. Approximately 20% of the population consume 56% of the health care expenditure, mainly funded by Medical Insurance. A tax-funded state health care system serves the rest of the population, but is concentrated on improving sanitation and primary health care. Diversion of funds from academic tertiary hospitals has reduced specialised services, particularly cardiology and cardiac surgery, and has resulted in an exodus of skilled personnel to the private sector. In the rest of sub-Saharan Africa, tertiary health care is mainly privately funded. Cardiology and cardiac surgery is not widely available. Many countries are crippled by debt and chronic local conflicts. Only one state hospital (Groote Schuur, Cape Town) provides an electrophysiology (EP) service including catheter ablation and ICD implantation, and training in EP, by two electrophysiologists. EP services are available privately in 3 centres. No EP service exists in the rest of sub-Saharan Africa.

Africa↗
PubMed1994

Surgical cure of the Wolff-Parkinson-White syndrome--a comparison of two techniques.

Curative arrhythmia surgery for patients with symptomatic Wolff-Parkinson-White syndrome (WPW) was first performed in South Africa in November 1987. Pre-operatively all patients were symptomatic despite medical therapy, and 32% were assessed as being at risk for sudden death. The first 9 patients (November 1987 to December 1989) underwent either epicardial or localised endocardial surgical dissections, and a cure was obtained in 66%. Aberrant atrioventricular conduction recurred in 2 patients, 3 degrees atrioventricular heart block occurred in 2 patients, and there was 1 postoperative death in a patient who had undergone simultaneous coronary artery bypass grafting. In contrast, a standardised endocardial technique was used in the subsequent 10 patients. Surgical cure was obtained in all 10 patients (P < 0.01). However, 1 patient required reoperation 24 hours after the first procedure because of early postoperative recurrence due to initial incorrect pathway localisation. This was successful. There were no deaths, and no patient developed atrioventricular heart block. In view of the excellent surgical results, arrhythmia surgery should be considered in select WPW patients who either have refractory symptoms or are at risk for sudden death. Furthermore, this reliable surgical technique provides an essential back-up should alternative interventional procedures such as percutaneous radiofrequency ablation fail.

Adolescent↗
PubMed1983

Temporary transvenous atrial pacing for the control of supraventricular tachycardia in the coronary care unit.

Until the present, temporary atrial pacing techniques for acutely ill patients with supraventricular arrhythmias have been most widely used following open heart surgery. The recent availability of stable J-shaped temporary atrial pacing catheters promises to broaden the use of atrial pacing to patients with such arrhythmias who have not had a thoracotomy. Two cases with resistant supraventricular arrhythmias were successfully treated using temporary transvenous pacing leads placed in the right atrial appendage.

Arrhythmias, Cardiac↗
PubMed1978

Prolonged circulatory support with the intra-aortic balloon pump after myocardial infarction.

Circulation was supported by intra-aortic balloon counterpulsation for 30 and 38 days respectively in two patients with cardiogenic shock after acute myocardial infarction. One was flown 1400 km to Cape Town for heart transplantation but died after being weaned from the pump while awaiting a suitable donor. The other underwent successful surgical closure of a ruptured ventricular septum on the 30th day, allowing time for the edges of the ventricular septal defect to fibrose. Neither significant damage to circulating blood elements nor infection occurred, confirming the feasibility of prolonged circulatory support.

Acute Disease↗