Biomedical subjects

S Inbar

Publications and source records attributed to S Inbar.

13 recordsLinked to original sources

PubMed2000

Uncertainty principle of signal-averaged electrocardiography.

BACKGROUND: Signal-averaged ECG (SAECG) reproducibility is reported to have a component that is independent of residual noise. Methods and Results-In group 1, multiple paired SAECGs were obtained to noise levels of 0.3+/-0.1 and 0.5+/-0.2 microV. For the 0.5- and 0. 3-microV noise recordings, QRS duration (QRSd) was 101.2+/-11.3 and 104.6+/-9.6 ms, respectively (P<0.0001), and the differences in paired QRSd (DeltaQRSd) were normally distributed, with variances of 11.4 and 26.2 ms(2) (P<0.0001). Paired SAECGs were obtained in group 2 patients without and with late potentials; DeltaQRSd variance was 3.3 and 217.9 ms(2) (P<0.0001). In group 3, >/=10 SAECGs were acquired at noise levels of 0.2 to 0.8 microV, in 0.1-microV increments. QRSd increased as noise level decreased. The variance was greater in low-noise (0.2 to 0.4 microV) versus higher-noise (0. 5 to 0.8 microV) recordings. In group 4, SAECGs were analyzed with bidirectional and Bispec filters, with no difference in QRSd between the 2 filters and a normally distributed DeltaQRSd. A computer simulation demonstrated that alterations in the phase relationship of noise to signal results in a normal distribution of signal end points. CONCLUSIONS: Within the acceptable noise range for SAECG, lower noise results in longer QRSd and larger variance, suggesting that more accurate recordings may have less reproducibility. The random timing of noise relative to signal results in the distribution/variance of repeated measurements. Statistical strategies may be used to reduce some of this variance and may enhance the diagnostic utility of SAECG.

Adult↗

PubMed1997

Utility of predischarge and one-month transvenous implantable defibrillator tests.

We evaluated the utility of performing predischarge implantable cardioverter-defibrillator (ICD) testing and ICD testing at 1 month in detecting ICD-related problems, identifying 4 patients with an unacceptable increase in defibrillation threshold. Given that ICD testing is noninvasive and has minimal (if any) associated risk, we recommend that predischarge and 1-month follow-up ICD testing should be performed after implantation.

Aged↗

PubMed1997

Autonomic effects on noise recorded during signal-averaged electrocardiography.

The purpose of this study was to assess the effects of autonomic stimulation and blockade on noise levels and to compare the noise measurements in the ST and TP segments of the signal-averaged ECG. Five-minute electrocardiographic data were recorded in 14 normal volunteers (8 males and 6 females; mean age 28.5 +/- 5.0 years) on two separate days (day 1-baseline, epinephrine infusion, isoproterenol infusion, beta-blockade, and combined adrenergic and parasympathetic blockade; day 2-baseline, phenylephrine infusion, parasympathetic blockade, and during phenylephrine infusion following atropine). Signal averaging was done off-line on 100 beats and noise was measured in both the ST and TP segments as the standard deviation of voltage in the segment of interest. For all conditions tested, the mean noise level measured in the ST segment (0.46 +/- 0.16 microV) was significantly less than that measured in the TP segment (0.52 +/- 0.24 microV; P = 0.0003), but there was good correlation between the noise measured in the ST and the TP segment (R2 = 0.62, P < 0.0001). Noise increased with isoproterenol infusion and decreased following adrenergic blockade. In addition, day 2 baseline noise was less than baseline noise on day 1. Finally, neither parasympathetic stimulation or blockade nor alpha-adrenergic stimulation significantly affected signal-averaged electrocardiography (SAECG) noise levels. Thus, the data support the notion that enhanced sympathetic tone increases noise levels and beta-adrenergic blockade may decrease noise levels, likely due to effects from muscle sympathetic nerve activity. These findings are important since the target population for the SAECG are patients with myocardial infarction and congestive heart failure, conditions associated with increased sympathetic tone, which may in turn impact on the reproducibility or technical aspects of the SAECG. In addition, because noise in the ST and TP segments are highly correlated and the noise measured in the ST segment is less than that in the TP segment, uniform adoption of noise measurement in the ST segment seems most appropriate.

Adrenergic Antagonists↗

PubMed1997

Late recurrence of atrial flutter following radiofrequency catheter ablation.

The success rate for catheter ablation of atrial flutter has been reported to be approximately 90%, but recurrences are common and can be seen in up to 20% of cases. Most of these recurrences are seen within a few weeks following ablation. We report on a patient who developed a recurrence of type I atrial flutter 2 years after an initially successful radiofrequency catheter ablation procedure. Whether the recurrent atrial flutter is due to a new reentrant circuit resulting from slow progression of atrial disease or due to the changes produced by radiofrequency energy in the nearby myocardium is not clear. Further work to define the electrophysiological changes in the atrial myocardium produced by radiofrequency energy, as well as long-term follow-up of patients undergoing radiofrequency catheter ablation for atrial flutter may help in answering these questions.

Atrial Flutter↗

PubMed1996

Challenges of device therapy for ventricular tachycardia in the rate range of sinus rhythm.

A method is described for patient-activated detection of ventricular tachycardia, under circumstances in which automatic algorithms fail. We present a case of a patient with an implanted defibrillator (Jewel PCD) who presented with symptomatic exercise-induced ventricular tachycardia that was only marginally faster than the preceding sinus tachycardia. Programming the sudden onset criterion avoided delivery of therapy into sinus tachycardia, but failed to detect ventricular tachycardia. Brief application of a magnet resulted in successful detection and therapy. This method is device-specific and requires a co-operative, insightful patient. The benefits and risks of such an approach are discussed.

Defibrillators, Implantable↗

PubMed1996

Local electrogram changes in response to a high-voltage intracardiac shock in humans.

INTRODUCTION: Transvenous defibrillators may have difficulty sensing ventricular fibrillation following an unsuccessful shock. This study was undertaken to characterize the changes that occur in intracardiac electrograms following a defibrillator shock that may contribute to the failure to redetect arrhythmias. METHODS AND RESULTS: Unipolar and bipolar electrogram recordings were made during sinus rhythm before and following monophasic and biphasic test shocks delivered in random order through a single lead defibrillator system in 15 patients. An additional 14 patients received only a biphasic shock. Electrogram amplitude, dV/dt, and activation recovery time were determined. Following biphasic shocks, unipolar electrogram amplitude decreased by a mean of 19.6% and the bipolar amplitude by a mean of 20.8% (P = NS). The mean dV/dt in the unipolar recordings decreased by 30.7% and in the bipolar recordings decreased by 33.0% (P = NS). Time constants for recovery were approximately 60 seconds. Reduction in dV/dt was greater when the shocking coil was closer to the distal sensing electrode. There was no significant influence of shock waveform (monophasic vs biphasic), recording type (unipolar vs bipolar), or clinical variables on the change in electrogram characteristics. CONCLUSION: Changes in intracardiac electrograms following defibrillator shocks through transvenous leads are seen with shocks delivered in sinus rhythm and may be related to the proximity of the shocking coil to the distal sensing electrode.

Aged↗

PubMed1993

Effects of adenosine in combination with calcium channel blockers in patients with primary pulmonary hypertension.

OBJECTIVES: The purpose of this study was to evaluate the effects of vasodilator combination therapy in patients with primary pulmonary hypertension. BACKGROUND: Calcium channel blockers and adenosine have each been shown to be effective in reducing pulmonary artery pressure and pulmonary vascular resistance in patients with primary pulmonary hypertension. However, the effects of combining these vasodilators have not been studied. METHODS: To test the combination, 12 patients were placed on oral nifedipine and 3 on diltiazem therapy, using a dose titrated to maximal effect (mean nifedipine dose 103 +/- 24 mg, mean diltiazem dose 300 +/- 49 mg). Patients were then given maintenance doses of the calcium channel blocker at half the cumulative loading dose at 6-h intervals. One hour after the maintenance dose of calcium blocker, all patients received an infusion of adenosine, starting with 50 micrograms/kg per min and increasing by 50 micrograms/kg per min at 2-min intervals to a maximally tolerated dose (180 +/- 63 micrograms/kg per min). RESULTS: Ten patients responded to calcium channel blockers (defined as a > or = 20% decrease in pulmonary vascular resistance), with a 16% decrease in mean pulmonary artery pressure (p = 0.057), a 39% decrease in pulmonary vascular resistance (p = 0.002) and a 24% increase in stroke volume (p = 0.007). Five patients were nonresponders, with no significant changes in pulmonary artery pressure, pulmonary vascular resistance, cardiac index or stroke volume. In the calcium channel blocker responders, the combination of adenosine and calcium blocker reduced pulmonary vascular resistance by 49%, increased stroke volume by 33% and decreased mean pulmonary artery pressure by 14% compared with drug-free baseline values. In nonresponders, combination therapy resulted in nonsignificant changes in pulmonary artery pressure and pulmonary vascular resistance. CONCLUSIONS: Adenosine has the ability to further decrease pulmonary artery pressure and pulmonary vascular resistance in patients with primary pulmonary hypertension who respond to calcium channel blockers. Those who fail to respond to these agents have little added effect from adenosine.

Adenosine↗

PubMed1993

Case report: nuclear magnetic resonance imaging in a patient with a pacemaker.

The presence of a pacemaker has been considered a contraindication for magnetic resonance imaging (MRI) examination. The authors describe a patient with a pacemaker who underwent MRI of the head without sequelae. Spine-echo MRI was preformed with 1.5 Tesla imager using head coil only. Prior to imaging, the pacemaker was programmed to the OOO mode. In carefully selected pacing-independent patients, with a pacemaker in a bipolar configuration, MRI of the head appears to be safe provided the pacemaker is programmed to OOO and enough scar tissue has developed to prevent pacemaker or lead movement.

Adult↗

PubMed1993

Prediction of arrhythmic events after acute myocardial infarction using two methods for late potentials recording.

One hundred consecutive patients recovering from an acute myocardial infarction underwent, prior to home discharge, signal-averaged electrocardiography (ECG), left ventriculography, and 24-hour Holter ECG recording. The signal-averaged ECG was recorded and analyzed using two procedures: the orthogonal bipolar XYZ lead configuration with a bidirectional filter; and a precordial unipolar lead configuration with a nonrecursive digital filter. An abnormal signal-averaged ECG was seen in 40% of patients with the XYZ system and in 30% of patients in the precordial method, abnormal ejection fraction (< 40%) in 24% of patients and high grade ectopy activity in 22%. During the 24-month follow-up period, 12 patients (12%) had an arrhythmic event defined as either sudden death (11 patients) or sustained ventricular tachycardia (1 patient). Neither the signal-averaged ECG with the XYZ configuration, the abnormal ejection fraction, nor the high grade ectopy were able to statistically predict a higher arrhythmic event rate. The signal-averaged ECG with the precordial configuration was able to statistically predict a higher arrhythmic event rate, P < 0.03; odds ratio = 3.96. The combination of the orthogonal XYZ configuration signal-averaged ECG with the ejection fraction (P < 0.01, odds ratio = 7.33), or with ejection fraction and Holter monitoring (P < 0.06, odds ratio = 6.17) was able to predict a higher arrhythmic event rate. The combination of the precordial configuration signal-averaged ECG with the ejection fraction (P < 0.002, odds ratio = 14.4), or with ejection fraction and Holter monitoring (P < 0.06, odds ratio = 10) was able to better predict a higher arrhythmic event rate.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

PubMed1992

Comparison of the effects of adenosine and nifedipine in pulmonary hypertension.

The hemodynamic effects of intravenously administered adenosine, a potent vasodilator, were examined in 15 patients with pulmonary hypertension. All patients were given adenosine, 50 micrograms/kg per min, increased by 50 micrograms/kg per min at 2 min intervals to a maximum of 500 micrograms/kg per min or until the development of untoward side effects. The patients were then given oral nifedipine, 20 mg every hour, until a greater than or equal to 20% decrease in pulmonary vascular resistance or systemic hypotension occurred. The administration of maximal doses of adenosine, 256 +/- 46 micrograms/kg per min, produced a 2.4% reduction in pulmonary artery pressure (p = NS), a 37% decrease in pulmonary vascular resistance (p less than 0.001) and a 57% increase in cardiac index (p less than 0.001). The administration of maximally effective doses of nifedipine (91 +/- 36 mg) produced a 15% reduction in the mean pulmonary artery pressure (p less than 0.05), a 24% decrease in pulmonary vascular resistance (p less than 0.01) and an 8% increase in cardiac index (p = NS). There was a significant correlation (r = 0.714, p = 0.01) between the reduction in pulmonary vascular resistance that resulted from adenosine administration and that achieved with the administration of nifedipine. Six patients had substantial reductions in pulmonary vascular resistance with adenosine but not with nifedipine. Thus, adenosine is an effective vasodilator in patients with pulmonary hypertension and can be used for safe and rapid assessment of vasodilator reserve in these patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Adenosine↗

PubMed1990

Dry chemistry thin film immunoassay.

The authors report the development of a novel thin film multilayer immunoassay technology. The technology is applied to therapeutic drug monitoring and thyroid hormone testing in serum or plasma and can be extended to assays of other low molecular weight analytes. The assay detection range spans five orders of magnitude, from 1 x 10(-3) to 1 x 10(-8) M. The assay element comprises of multilayer coated chip, containing the active reagents in an agarose matrix and a plastic module serving both as a holder and a spreader. The assays are in the fluorescent competitive immunoassay format of the ligand displacement mode and are performed on an automated instrument with random access capability. The assays are fast and reliable and gave very good agreement when compared to reference methods.

Immunoassay↗

PubMed1990

Development of monoclonal antibodies for therapeutic drug monitoring.

For the development of multilayer fluorescent immunoassays to determine directly a variety of therapeutic drugs high specific monoclonal antibodies against the anticonvulsants carbamazepine, phenobarbital, phenytoin and valproic acid have been prepared. For each antibody a standard curve could be established showing good linearity and a suitable sensitivity scope. To validate the eligibility of the desired antibodies a variety of drugs and metabolites sharing structural similarities to the individual drugs were tested for their cross-reactivity. It could be shown that only a few very closely related compounds exhibited substantial cross-reactivity. These monoclonal antibodies are therefore assumed to be suitable for a TDM-assay development.

Antibodies, Monoclonal↗

PubMed1989

Multilayer fluorescent immunoassay technique.

We describe a new multilayer immunoassay element for the determination of haptens in undiluted serum and plasma. Polysaccharide layers are coated onto a plastic base. The signal layer contains an immobilized antibody and a fluorescent-labeled hapten. A second layer, containing a pigment, acts as an optical screen. Sample spreading is achieved by a molded grid in contact with the upper layer of the immunoassay element. After sample is added to the element, endogenous analyte competes with the labeled hapten for the binding sites of the immobilized antibody; equilibrium is reached in 4-12 min. Because of the relative liquid-holding capacities of the layers and the grid, only a small amount of the free components remains in the signal layer. The signal is measured by front-surface fluorimetry. This technology has been applied to theophylline and thyroxin assays. Within- and between-run CVs range from 3% to 6%. Comparisons with fluorescent polarization immunoassays (Abbott TDx) showed excellent correlation (theophylline: r = 0.98, slope = 1.07, intercept = 0.3; thyroxin: r = 0.97, slope = 0.91, intercept = 0.8). The new method requires only one pipetting step (sample delivery) and is potentially applicable to a wide range of analytes.

Fluorescence Polarization↗