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T Zheutlin

Publications and source records attributed to T Zheutlin.

6 recordsLinked to original sources
PubMed1989

New approach to defibrillator insertion.

The automatic implantable cardioverter/defibrillator has become an integral part of the management of patients with life-threatening ventricular rhythm disturbances. The considerable size of the device (250 gm, 10.8 by 7.6 cm) results in protrusion from the abdominal wall, with an associated alteration in self-image in all patients. In thin patients, erosion through the skin can occur. We have devised an operation in which the generator is implanted in, and becomes part of, the chest wall. The two patients in whom this approach has been used are virtually unaware of the presence of the device. We propose this operation as an alternative to abdominal wall insertion when the latter is unsuitable for technical reasons.

Aged↗
PubMed1988

Factors determining programmed stimulation responses and long-term arrhythmic outcome in survivors of ventricular fibrillation with ischemic heart disease.

The clinical and angiographic features of 38 patients with ischemic heart disease and nonacute infarction pre-hospital ventricular fibrillation (VF) were examined as a function of their drug-free programmed electrical stimulation (PES) responses. Twenty-two patients (58%) had inducible ventricular tachycardia (VT) at drug-free PES (group I) and 16 patients (42%) did not (group II). Group I had more patients with: (1) remote infarction (22 of 22 vs 2 of 16; p less than 0.01; (2) history of congestive failure (16 of 22 vs 0 of 16; p less than 0.01); (3) prior cardiac arrest (11 of 22 vs 0 of 16; p less than 0.01); (4) left ventricular (LV) ejection fraction less than 40% (19 of 22 vs 1 of 16; p less than 0.01); and (5) akinetic or dyskinetic LV wall motion (22 of 22 vs 2 of 16; p less than 0.001). Group II had more patients with: (1) LV segments at "ischemic jeopardy" (16 of 16 vs 14 of 22; p less than 0.01) and (2) factors suggestive of ischemia at the onset of VF (13 of 16 vs 1 of 22; p less than 0.001). Inducible VT (IVT) was suppressed in 16 of the 20 group I patients surviving hospitalization while four were discharged with persistence of IVT despite therapy. At 27 +/- 15 months, all four with persistent IVT had a recurrence of their arrhythmia. In the 16 group II patients, therapy was limited to antiischemic measures: coronary bypass in 12, propranolol in 3, and angioplasty in one. At 38 +/- 9 months, no group II patient has had a recurrence of his arrhythmia.(ABSTRACT TRUNCATED AT 250 WORDS)

Angina Pectoris↗
PubMed1988

Low heart rate variability and sudden cardiac death.

Our results indicate the following. 1. HRV is markedly depressed in inducible SCD survivors, a group at high risk of a subsequent episode of SCD. 2. Studies on patients who developed SCD during Holter monitoring indicate that HRV is depressed prior to SCD. 3. HRV is markedly depressed in inducible "asymptomatic ventricular ectopy" patients, with the degree of reduction paralleling that observed in inducible SCD survivors. In contrast, HRV of noninducible "asymptomatic ventricular ectopy" patients did not differ statistically from normal. 4. The findings provide additional evidence that cardiac parasympathetic function is depressed in patients prone to development of SCD and that altered autonomic function contributes to the development of electrical instability in such individuals. This accords with findings that such risk factors for sudden death as coronary artery disease, myocardial infarction, congestive failure, and hypertension all have been associated with reduced parasympathetic activity or attenuation of parasympathetically mediated reflexes. It is tempting to believe that diminished cardiac parasympathetic activity, perhaps by failing to counter excess sympathetic activity, contributes to SCD. 5. It may be inferred that HRV measurements have potential for serving as an independent predictor of inducibility in response to programmed ventricular stimulation and that they could represent a noninvasive screen for patients referred for evaluation of risk of SCD because of asymptomatic ventricular ectopy or other causes. In a larger sense, the data suggest that HRV measurements may provide information pertinent to the identification of individuals at increased risk of SCD that is independent of that provided by other risk factors. Given the human and economic stakes, further study is clearly warranted.

Death, Sudden↗