Biomedical subjects

Stuart Beldner

Publications and source records attributed to Stuart Beldner.

6 recordsLinked to original sources

PubMed2006

Predictors of success after selective pulmonary vein isolation of arrhythmogenic pulmonary veins for treatment of atrial fibrillation.

BACKGROUND: Atrial fibrillation (AF) ablation procedures typically involve isolation of all pulmonary veins (PVs) in addition to adjunctive linear lesions, yet the need for such an extensive ablation strategy in all patients is unclear. OBJECTIVES: The purpose of this study was to identify a subgroup of patients undergoing AF ablation with good clinical success after limited PV isolation. METHODS: Patients (N = 450) underwent trigger-guided segmental isolation of only arrhythmogenic PVs. We compared clinical characteristics of patients who required isolation of only one or two PVs to those in whom AF ablation required isolating > or = 3 PVs. RESULTS: For the group of patients undergoing isolation of < or = 2 PVs, AF freedom without antiarrhythmic drug use was achieved in 56 (58%) of 97 patients, and AF control was achieved in 66 (68%) of 97 patients after a single procedure. After additional procedures, 77 (79%) of 97 patients achieved complete AF freedom without antiarrhythmic drugs, and 82 (85%) of 97 patients achieved AF control. Younger age (odds ratio [OR] 1.05; confidence interval [CI] 1.01,1.09) and lack of persistent AF (OR 3.27; CI 1.0, 10.7) were each independent predictors of freedom from AF. In patients younger than 50 years with paroxysmal AF undergoing isolation of < or = 2 PVs (n = 44), AF freedom without antiarrhythmic drugs was achieved in 32 (73%) of 44 after a single ablation procedure. CONCLUSION: Targeted PV isolation has a good long-term (18-month) success rate in patients younger than 50 years with paroxysmal AF and < or = 2 PVs triggering AF.

Atrial Fibrillation↗

PubMed2005

Ventricular tachycardia/ventricular fibrillation ablation in the setting of ischemic heart disease.

Recurrent ventricular tachycardia (VT) in the setting of coronary artery disease is frequently a life-threatening electrophysiologic emergency. Even in patients with an implantable defibrillator, recurrent VT is frequently accompanied by repeated and disabling shock therapy. Catheter ablative therapy offers the ability to provide immediate control of recurrent VT. Long-term elimination of VT should be anticipated in most patients. This article reviews the strategies, tools, techniques, and expected outcome for catheter ablation of stable and unstable ventricular arrhythmias in the setting ischemic heart disease.

Catheter Ablation↗

PubMed2004

Flecainide and propafenone induced ST-segment elevation in patients with atrial fibrillation: clue to specificity of Brugada-type electrocardiographic changes.

Potent sodium channel, blockade with type IC antiarrhythmics can provoke characteristic electrocardiographic changes consistent with Brugada's syndrome in unselected patients with atrial fibrillation. In 176 treated patients, the incidence of the characteristic abnormality is small (2.3%), and thus although no ventricular arrhythmia events were observed during follow-up, the long-term clinical significance in a larger patient cohort remains to be determined. These data provide insight into the specificity of the response to type I drug administration in patients suspected of having Brugada's syndrome.

Anti-Arrhythmia Agents↗

PubMed2002

Septic coronary embolism.

This report describes a case of a 31-year-old woman with mitral valve endocarditis complicated by a septic embolus to a coronary artery.

Adult↗

PubMed2002

Is telemetry monitoring necessary in low-risk suspected acute chest pain syndromes?

BACKGROUND: Non-ICU telemetry monitoring has proven to be a valuable resource for patients suspected of having an acute myocardial infarction. While a significant number of patients are admitted to these units, the actual incidence of events or interventions is low. OBJECTIVE: To identify a subset of patients in whom telemetry monitoring does not alter management. DESIGN: Prospective observational study. SETTING: Large tertiary care facility. PATIENTS: A total of 414 patients consecutively admitted from the emergency department for suspected acute coronary syndromes were studied. Patients were excluded if they presented with ST-segment elevations, were revascularized on hospital admission, were admitted to a surgical service, were transferred from another floor or unit, or remained in the emergency department for the course of the stay. OUTCOMES: Events were defined as development of myocardial infarction, episodes of chest pain, new or rapid atrial arrhythmias, ventricular arrhythmias, any form of AV nodal block, and asystole. Intervention or change in management was any increase, decrease, or change in medication, cardioversion, electrophysiology study, or transfer to the ICU. RESULTS: Patients who had atypical chest pain and normal ECG findings were significantly less likely to have both intervention and events (4 interventions vs 23 interventions [p < 0.0001], 12 events vs 45 events [p < 0.0001]), compared to those with typical chest pain and abnormal ECG findings. When normal laboratory values were added, only four telemetry events were observed. CONCLUSION: Patients with atypical chest pain and normal ECG findings represent a subset of patients with low risk for life-threatening arrhythmia. Use of telemetry monitoring in this subset of patients should be reevaluated.

Acute Disease↗

PubMedDate not supplied

Coronary artery dissection during pregnancy treated with medical therapy.

Spontaneous coronary artery dissection is a rare etiology of myocardial infarction with a higher noted incidence in pregnancy. The recognition and proper treatment of this condition affects patient outcomes. We report the case of a coronary artery dissection during a twin pregnancy involving the left anterior descending artery. Successful treatment with medical management was possible once spontaneous reperfusion had been achieved.

Adrenergic beta-Antagonists↗