[Development of "endless loop tachycardia" after exhaustion of the power source of a DDD type pacemaker].
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Biomedical subjects
Publications and source records attributed to S S Grigorov.
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Twenty years' experience with continuous endocardial stimulation of the heart is summed up. The bulk of the reviewed data falls to the period of 1980 through 1985, when 1776 primary implantations were performed, whereas more than 3,000 implantations have been performed in the past 6 years. Opinions are voiced on many aspects related to endocardial stimulation. Endocardial application of electrodes is believed to be the principal method, while myocardial stimulation should only be done simultaneously with heart surgery. Electrode application via puncture is discussed with special reference to its advantages (possible application of two electrodes at once, small cosmetic defect) and possible side effects. The results obtained with a borer electrode, designed by the authors, are reported (130 cases). Complications associated with developing rhythm competition are discussed. It is proposed that the manufacture of asynchronous pacemakers be limited considerably, and that they should mostly be implanted in cases of clinically manifest myopotential inhibition.
Rhythm disturbances induced by endocardial pacing were studied in 15 patients. Atrial extrasystoles were found in 8, ventricular extrasystoles in 5, ventricular tachycardia in 1 and ventricular fibrillation in 1 patient. In all cases, an implanted pacemaker EKS-222 was used working in VVI regime. The connection of the above-mentioned rhythm disturbances with pacing is deduced from the stability of the coupling interval with the earlier induced complex, and from the presence of a negative P wave in standard leads II and III. A reliable criterion is in the authors' view, the disappearance of rhythm disturbances after the implanted pacemaker has been switched off.
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The results of decelerating stimulation of the heart in 52 patients with tachysystolic complications of various etiology were studied. Paired and combined stimulation of the ventricles induced artificial rhythm in 41 patients (78.9%), in 5 patients (9.6%) the paroxysmus of tachycardia were arrested when the electrode was being inserted into the right ventricle. Favourable results were produced in 29 patients (70.7%).
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The authors analyse the indications for electric stimulation of the heart in disorders of atrioventricular conduction on the basis of personal experience (1000 odd electric stimulations). Two main factors, the frequency and severity of Morgangni-Adams-Stokes attacks and the state of hemodynamics, should be taken into account when the indications for electric cardiac stimulation are considered. In choosing the therapeutical measures and methods, due consideration should also be given to the etiology of the block. Morgagni-Adams-Stokes attacks are an absolute indication for permanent electric stimulation. The authors believe that as a method for the management of atrioventricular block electric stimulation of the heart has no absolute contraindications.
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To realize medical control over parameters of cardiostimulators a tester has been devised that makes it possible to exercise control over the principal parameters of implanted and external cardiostimulators, such as the amplitude, polarity and the pulse recurrence frequency, as well as the amplitude and frequency of switching on and off of the monitored stimulators, resistance of electrodes and the voltage of power supply batteries.
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Methods of topology and numerical parameters determination of electrode-bioobject-electrode equivalent circuit system was developed for electrocardiostimulants (ECS) operating under voltage source regime. It was established that in designing of ECS of the kind the rated value of load impedance be 200-300 omega. Empirical histograms and distribution law curves of RC-parameters of the mentioned equivalent circuit took into account the variability of these parameters both in patients and depending on the position of electrode heart as well.
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