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Biomedical subjects

Richard H Hongo

Publications and source records attributed to Richard H Hongo.

8 recordsLinked to original sources
PubMed2006

Status of computerized electrocardiography.

Since the first reports on computerized ECG analysis were published in the early 1960s, there have been major advancements in this technology that have led to the availability of a computer interpretation for nearly all ECGs processed in the United States. Misinterpretation of the ECG is still a problem, however, especially with rhythm diagnoses and correctly identifying pacemaker activity. A sound understanding of the strengths and limitations of the current computer analysis programs is essential to avoid over-reliance on computer analysis and to prevent the inappropriate management of patients. The reliability of computerized ECG analysis programs will only continue to improve, and the degree to which expert readers will continue to be needed remains to be seen. In the meantime, until there is true automated ECG analysis, computerized interpretations should be viewed as an adjunct to, not a substitute for, interpretation by a competent and experienced physician.

Electrocardiography↗
PubMed2004

Use of ibutilide in cardioversion of patients with atrial fibrillation or atrial flutter treated with class IC agents.

OBJECTIVES: We sought to assess the efficacy and safety of ibutilide cardioversion for those with atrial fibrillation (AF) or atrial flutter (AFL) receiving long-term treatmentwith class IC agents. BACKGROUND: Attenuation of ibutilide-induced QT prolongation has been observed in a small number of patients pretreated with class IC agents. The clinical significance of the interaction between ibutilide and class IC agents is unknown. METHODS: Seventy-one patients with AF (n = 48) or AFL (n = 23), receiving propafenone 300 to 900 mg/day (n = 46) or flecainide 100 to 300 mg/day (n = 25), presented for ibutilide (2.0 mg) cardioversion. RESULTS: The mean durations of arrhythmia episode and arrhythmia history were 25 +/- 48 days and 4.4 +/- 6.4 years, respectively. Sixty-five patients (91.5%) had normal left ventricular systolic function. Twenty-three of 48 patients (47.9%; 95% confidence interval, 33.3% to 62.8%) with AF and 17 of 23 patients (73.9%; 95% confidence interval, 51.6% to 89.8%) with AFL converted with mean conversion times of 25 +/- 14 min and 20 +/- 12 min, respectively. There was a small increase in corrected QT interval after ibutilide (from442 +/- 61 ms to 462 +/- 59 ms, p = 0.006). One patient developed non-sustained polymorphous ventricular tachycardia and responded to intravenous magnesium. Another developed sustained torsade de pointes and was treated effectively with direct-current shock and intravenous dopamine. CONCLUSIONS: Our observations suggest that the use of ibutilide in patients receiving class IC agents is as successful in restoring sinus rhythm and has a similar incidence of adverse effects as the use of ibutilide alone.

Aged↗
PubMed2004

Famotidine and long QT syndrome.

Numerous drugs have been implicated in causing a prolonged QT interval and Torsades de pointes. However, the association of famotidine and acquired long QT syndrome has rarely been reported. We report 2 cases of famotidine-associated acquired long QT syndrome.

Aged↗
PubMed2003

Pseudo-cross-stimulation due to first degree AV block.

During routine interrogation of a dual chamber pacemaker, atrial pacing stimulus outputs were found to coincide with surface electrogram QRS complexes raising concern for cross-stimulation. Scrutiny of the native rhythm, however, confirmed this to be "pseudo-cross-stimulation" where marked first degree AV block resulted in alignment of atrial stimulus outputs with preceding QRS complexes. Although cross-stimulation is rare, familiarity with cross-stimulation and pseudo-cross-stimulation is important because its recognition will avoid erroneous diagnoses of lead dislodgment or device malfunction.

Atrioventricular Node↗
PubMed2002

The effect of clopidogrel in combination with aspirin when given before coronary artery bypass grafting.

OBJECTIVES: This study was designed to evaluate the effect of preoperative clopidogrel on coronary artery bypass graft surgery (CABG) outcomes. BACKGROUND: Clopidogrel in combination with aspirin, given before percutaneous coronary intervention, has become the standard for stent thrombosis prevention. Some premedicated patients, however, are found to have surgical disease on angiography, and irreversible platelet inhibition becomes a concern for upcoming CABG. METHODS: We prospectively studied 224 consecutive patients undergoing nonemergent first-time CABG, and compared those with preoperative clopidogrel exposure within seven days (n = 59) to those without exposure (n = 165). RESULTS: The groups were comparable in age, gender, body surface area, preoperative hematocrit, preoperative prothrombin time and prior myocardial infarction. The clopidogrel group had higher 24-h mean chest tube output (1,224 ml vs. 840 ml, p = 0.001), and more transfusions of red blood cells (2.51 U vs. 1.74 U, p = 0.036), platelets (0.86 U vs. 0.24 U, p = 0.001) and fresh frozen plasma (0.68 U vs. 0.24 U, p = 0.015). Moreover, reoperation for bleeding was 10-fold higher in the clopidogrel group (6.8% vs. 0.6%, p = 0.018). The clopidogrel group also had less extubation within 8 h (54.2% vs. 75.8%, p = 0.002) and a trend towards less hospital discharge within five days (33.9% vs. 46.7%, p = 0.094). CONCLUSIONS: Clopidogrel in combination with aspirin before CABG is associated with higher postoperative bleeding and morbidity. These findings raise concern regarding the routine administration of clopidogrel before anticipated coronary stent implantation.

Aged↗
PubMed2002

Cutting balloon angioplasty through stent struts of a jailed sidebranch ostial lesion.

The treatment of sidebranch ostial lesions jailed after stent implantation is challenging. We report a case of successful Cutting Balloon angioplasty through stent struts of a severe, elastic sidebranch ostial lesion. Three-day follow-up angiography showed no recurrent stenosis. The patient was discharged with complete resolution of chest discomfort and the post-hospitalization course was uneventful. Cutting Balloon angioplasty may be an optimal strategy for the treatment of elastic ostial lesions in smaller vessels that are suboptimal for stenting. The long-term benefits of using a Cutting Balloon for the treatment of sidebranch ostial lesions are still to be determined.

Angioplasty, Balloon, Coronary↗