Biomedical subjects

S L Pinski

Publications and source records attributed to S L Pinski.

76 records · Page 5Linked to original sources

PubMed1990

Serial electrophysiologic testing of drug therapy in supraventricular tachycardia related to accessory pathways.

Data are limited on the use of serial electrophysiologic testing of drug therapy in patients with supraventricular tachycardia associated with accessory pathways, including the Wolff-Parkinson-White syndrome. Twenty-four highly symptomatic patients (aged 36 +/- 11 years) with SVT related to accessory pathways underwent electrophysiologic studies to select an effective chronic oral treatment. Conventional (verapamil, propranolol, quinidine, disopyramide) and investigational (amiodarone, aprindine, propafenone) drugs were used alone and in combination if necessary. It was determined that serial electrophysiologic studies could identify potentially effective treatments in 66% of patients with reentrant SVT involving accessory pathways, and the findings were highly predictive of long-term clinical outcome.

Adult↗

PubMedDate not supplied

Antiarrhythmic drug initiation in patients with atrial fibrillation.

Antiarrhythmic drugs remain the mainstay of treatment of atrial fibrillation, but their potential proarrhythmic effects hamper their optimal use. Drug-induced tachyarrhythmias (ventricular tachycardia or atrial tachyarrhythmias with rapid ventricular response) are life-threatening and often cause syncope. Because these events tend to cluster shortly after drug initiation, it is common practice to routinely hospitalize patients for drug initiation under continuous electrocardiographic surveillance. The low incidence of serious proarrhythmia makes the cost-effectiveness of this practice controversial. Torsades de pointes, in particular, can be predicted by the presence of one or more of the following risk factors: female gender, structural heart disease, prolonged baseline QT interval, bradycardia, hypokalemia, previous proarrhythmic responses, and higher drug plasma levels. Proarrhythmia induced by class IC agents is seen almost exclusively in patients with structural heart disease and ventricular dysfunction. A variety of monitoring devices permit electrocardiographic monitoring of patients in the outpatient setting. Efficient clinical pathways for the safe initiation of antiarrhythmic drugs in patients with atrial fibrillation do not require universal hospital admission. In patients without structural heart disease, outpatient initiation of most antiarrhythmic drugs appears safe. In patients with significant structural heart disease, class IC drugs are contraindicated, and most other drugs should be initiated in the hospital under continuous monitoring. The incidence of severe proarrhythmia is very low when loading doses of amiodarone of 600 mg/d or less are given to outpatients with structural heart disease.

Anti-Arrhythmia Agents↗

PubMedDate not supplied

Indications for electrophysiologic study in patients with ventricular arrhythmias.

Electrophysiologic study provides valuable information in the management of patients with known or suspected ventricular tachyarrhythmias. It should be used when there is uncertainty about the origin of a wide QRS tachycardia. It is useful in evaluating heart disease patients with unexplained syncope and in stratifying prognosis and guiding therapy in patients with malignant ventricular arrhythmias. All patients being considered for treatment of ventricular tachyarrhythmias with an electrical device should undergo thorough electrophysiologic study. Electrophysiologic study is also indispensable in guiding ablative therapy in patients with drug-refractory malignant ventricular arrhythmias.

Adult↗

PubMedDate not supplied

Durability of bipolar coaxial endocardial pacemaker leads compared with unipolar leads.

BACKGROUND: The coaxial design allows for thinner bipolar endocardial pacemaker leads, but recent reports have suggested a higher incidence of failure for this sophisticated configuration. OBJECTIVE: To compare the long-term survival of bipolar coaxial and unipolar leads. METHODS: Retrospective follow-up. RESULTS: Between January 1, 1980 and June 30, 1991, 1142 bipolar coaxial leads and 1181 unipolar leads were implanted at the Cleveland Clinic. The mean follow-up was 33 +/- 32 months (range 1 to 138 months). Ten bipolar coaxial leads failed (0.88%), as did 9 unipolar leads (0.76%). At 5 years the cumulative survival was 98.6% for both types of leads; however, at 10 years the survival of bipolar coaxial leads was only 92.4% compared with 98.6% of unipolar leads (P = .03; relative risk 2.7, 95% confidence interval = 1.1 to 6.9). CONCLUSIONS: The sophisticated design of bipolar coaxial leads could be the cause of their increased vulnerability. The benefit-to-risk ratio of this design should be prospectively reevaluated.

Electrodes, Implanted↗