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Biomedical subjects

V Kühlkamp

Publications and source records attributed to V Kühlkamp.

At least 73 records · Page 4Linked to original sources
PubMed1991

Randomized comparison of flecainide and cibenzoline in the conversion of atrial fibrillation.

The efficacy of oral cibenzoline (260 mg/day and 320 mg/day) and flecainide (200 mg/day and 300 mg/day) in the conversion of chronic atrial fibrillation to sinus rhythm were compared in 31 patients in a randomized order. If sinus rhythm was not restored on the 5th day of oral treatment with either cibenzoline or flecainide (phase of initial treatment) patients were switched to a second phase of treatment with the drug not given in the first phase after a washout phase of 3 days. Sinus rhythm was restored in 7/28 treatment trials with cibenzoline and in 7/23 treatment trials with flecainide (not significant). Trough levels of cibenzoline and flecainide in the plasma were not significantly different between patients in whom sinus rhythm was restored and patients with persisting atrial fibrillation. In patients successfully converted to sinus rhythm, long-term treatment was instituted with flecainide (n = 6) or cibenzoline (n = 6). Atrial fibrillation developed in 2 patients in each group of patients within 3 months. In all other patients, sinus rhythm was maintained during the follow-up period of 12 months. Non-cardiac side effects were observed in 2 patients during treatment with cibenzoline and flecainide respectively. With flecainide, one patient developed sinus arrest up to 5.6 seconds.

Adult↗
PubMed1991

[Value of diagnostic methods in conduction disorders for pacemaker indications and choice of a suitable stimulation mode].

Sinus node syndrome: In patients with sinus node dysfunction, additional conduction disturbances may be present in the AV-node thereby precluding the possibility for basically-desirable atrial stimulation. Systematic electrophysiologic studies have shown that, overall, conduction disturbances are uncommon, albeit more frequently than in normal subjects and most are incurred a high rate of stimulation. In practice, invasive electrophysiologic studies are not required to clarify this question. If there is no high-grade AV-block on Holter monitoring, diagnostic atrial stimulation can be carried out at the time of pacemaker implantation via the atrial electrode. A low rate should be used initially then increased gradually. On 1:1 conduction to 130 to 140 b/min permanent atrial pacing is possible since under these conditions it is very unlikely that high-grade AV-block will occur. If AV-block is observed at an atrial rate of 130 b/min, an additional ventricular electrode for two-chamber pacing should be implanted. If there is intact retrograde ventriculo-atrial (V-A) conduction, isolated ventricular stimulation should not be carried out because of the possibility of hemodynamically-unfavorable pacemaker syndrome. Possible problems with intact V-A conduction currently have only negligible importance since the development of modern programmable two-chamber systems. Carotid sinus syndrome: On manipulation of the hypersensitive carotid sinus, the invariably-present functional compromise of the AV-node is masked by the marked bradycardia but can be detected by atrial stimulation. This examination is not routinely necessary however, since in carotid sinus syndrome isolated atrial stimulation is not carried out.(ABSTRACT TRUNCATED AT 250 WORDS)

Arrhythmias, Cardiac↗
PubMed1991

[Perforation of the vascular wall after coronary excimer laser angioplasty].

A 56-year-old patient with recurrent episodes of angina pectoris at rest was admitted for left-heart catheterization. The coronary angiogram revealed two-vessel disease with a subtotal stenosis in the circumflex artery and a long 90% stenosis in the proximal part of the left anterior descending artery. On the basis of symptoms and coronary morphology laser angioplasty was performed. After a total of 99 s of energy delivery extravasation of dye occurred at the site of ablation. Due to acute vessel occlusion subsequent PTCA was performed, resulting in a satisfactory angiographic result. Extravasation of dye was terminated after PTCA and was absent at short-term follow-up angiography. No signs of pericardial effusion were detectable by two-dimensional and M-mode echocardiography. A control angiogram disclosed the identical result the day after the acute intervention, and the patient could be discharged with a normal exercise test 1 week later.

Angina Pectoris↗
PubMed1990

[Myocardial effects of the calcium antagonists nifedipine, nisoldipine and isradipine in coronary heart disease].

Cardiac and peripheral effects of three calcium antagonists of the dihydropyridine group were compared in three groups of ten men each with coronary heart disease (mean age 56 +/- 6 years). Dosages (by 30 minutes intravenous infusions) were: 2 mg nifedipine in group I, 0.5 mg nisoldipine in group II and 0.5 mg isradipine in group III. In this dosage peripheral effects--decrease of peripheral vascular resistance and mean aortic pressure--did not differ significantly between them. As a consequence of different negative chronotropic properties the extent of the observed reflex tachycardia was different: there was no significant heart rate increase after isradipine, an increase by 9.8% (P less than or equal to 0.001) after nifedipine and by 20.4% (P less than or equal to 0.001) after nisoldipine. Left-ventricular pressure-rise velocity as a parameter of myocardial contractility rose by 15.3% in group II (P less than or equal to 0.001) and by 13.5% in group III (p less than or equal to 0.001), but not in group I. These data show, that peripheral equipotent dosages of the three calcium antagonists can have different myocardial effects.

Blood Pressure↗
PubMed1990

Electrophysiologic effects and efficacy of cibenzoline on stimulation-induced atrial fibrillation and flutter and implications for treatment of paroxysmal atrial fibrillation.

The effects of intravenous cibenzoline (1.5 mg/kg) on atrial vulnerability and electrophysiology were assessed in 25 patients with documented paroxysmal atrial fibrillation (AF), in whom sustained (greater than 30 seconds) AF was induced by atrial stimulation with up to 2 extrastimuli and paced rates between 100 and 180 beats/min. In 7 patients AF persisted despite the application of cibenzoline, and in 8 patients the induction of sustained AF was prevented by cibenzoline. Intraatrial conduction time, flutter cycle length and shortest ventricular cycle length during AF were increased by cibenzoline (p less than or equal to 0.01). Sinus cycle length was decreased (p less than or equal to 0.05), whereas sinus node recovery time remained unchanged. The effective refractory period of the right atrium was not significantly affected. Eight patients with frequent episodes of paroxysmal AF received oral cibenzoline for control of paroxysmal AF irrespective of the efficacy of intravenous cibenzoline. Prevention of stimulation-induced AF predicted successful treatment of paroxysmal AF (p = 0.018). Cibenzoline could be effective in the treatment of atrial arrhythmias, and selection of an antiarrhythmic therapy for recurrent AF seems to be useful.

Administration, Oral↗
PubMed1990

AV nodal reentrant tachycardia using three different AV nodal pathways.

In a patient with frequent paroxysmal supraventricular tachycardia, an electrophysiologic study was performed. Although by programmed atrial stimulation only double AV nodal pathways could be documented, three distinct forms of AV nodal reentrant tachycardia could be induced. By programmed atrial stimulation a typical AV nodal reentrant tachycardia was initiated, by programmed ventricular stimulation, an AV nodal reentrant tachycardia was induced with an antegrade conduction time of 215 ms and a retrograde conduction time of 160 ms. Furthermore, a third form of tachycardia was induced with alternating cycle length due to two different antegrade conduction times, whereas retrograde conduction time was almost identical, irrespective of the antegrade conduction time. The patient received betaxolol (20 mg day-1); during a second electrophysiologic study, the tachycardia could not be induced, and it did not occur spontaneously during a follow-up period of 14 months.

Atrioventricular Node↗
PubMed1990

Effects of intravenous cibenzoline on ventricular vulnerability and electrophysiology in patients with sustained ventricular tachycardia in comparison to a control group.

The electrophysiologic effects of intravenous (i.v. 1.5 mg/kg) cibenzoline were investigated in 13 patients with organic heart disease and supraventricular arrhythmias (control group) and 13 patients with drug refractory sustained ventricular tachycardia (VT group). In both groups, cibenzoline increased the effective refractory period (ERP) of the right ventricle (p less than or equal to 0.05), QRS duration (p less than or equal to 0.01), and QTc duration (p less than or equal to 0.01). Cycle length of the VT was increased from 311 +/- 73 to 393 +/- 119 ms (p less than or equal to 0.05) as well. The increase in QTc duration was more pronounced (p less than or equal to 0.05) in the VT group as compared with the control group. In four patients in the VT group with the largest increase in QRS-, QTc duration and cycle length of the VT proarrhythmia was noted after i.v. cibenzoline. Cibenzoline plasma levels were not significantly different between the two study groups. In the VT group, induction of VT was prevented in 2 patients, more difficult in 2 patients, easier in 1 patient, and unchanged in 5 patients. Spontaneous occurrence of the VT or induction by atrial stimulation was noted in 4 patients. In the control group, ventricular vulnerability remained unchanged. Cibenzoline may be effective in selected patients with drug refractory VT. In such patients, the increase in QTc duration was more pronounced as compared with a control group.

Anti-Arrhythmia Agents↗
PubMed1990

[Electrophysiologic effects of penticainide in patients with supraventricular tachycardia].

The electrophysiologic effects of the new class-I antiarrhythmic drug pentisomide were investigated after intravenous (5 mg/kg) application in nine patients with atrioventricular nodal reentrant tachycardia and six patients with atrioventricular tachycardia. Pentisomide did not change sinus cycle length, effective refractory period of the right ventricle (ERP-RV), the AV-node (ERP-AVN) and QT interval. Intranodal (AH-interval) and infranodal conduction time (HV-interval), effective refractory period of the right atrium (ERP-A), QRS duration, antegrade effective refractory period of the accessory pathway (ERP-Kent), ventricular cycle length during atrial fibrillation and tachycardia cycle length were significantly (P less than 0.05) increased. Intravenous pentisomide prevented induction of the tachycardia in 5/9 patients with atrioventricular nodal tachycardia and in 2/6 patients with atrioventricular tachycardia. The electrophysiologic properties of pentisomide indicate that it might be a useful drug in the treatment of supraventricular tachycardia.

Adult↗
PubMed1990

[Occluding spasm of the total left coronary artery during coronary angiography].

Catheter-induced coronary artery spasms are rare during diagnostic coronary angiography, and they occur more often after PTCA because of local vessel wall injury. These spasms are rapidly reversible after administration of nitroglycerine and are normally no cause of serious complications. We report about a catheter-induced occlusive spasm of the entire left anterior descending and circumflex coronary artery in a 56-year-old patient with coronary double-vessel disease, 70% restenosis of the LAD, and a history of two coronary angiographic procedures and one PTCA without any complication. The spasm occurred immediately after the intubation of the left main stem with a 9F PTCA guiding catheter before the coronary guide wire or balloon was advanced into the LAD. Cardiac resuscitation was necessary due to acute left heart failure. The spasm was spontaneously reversible, but reproducible. Therefore, life-threatening coronary artery spasm can occur during coronary angiography or PTCA, but the tendency of spontaneous spasm relief seems to be high.

Angioplasty, Balloon, Coronary↗
PubMed1990

[Electrophysiologic effects of the calcium antagonist isradipine, a double-blind placebo controlled study].

The electrophysiologic effects of the calcium channel antagonist isradipine (0.5 mg) in comparison to placebo were evaluated in a double blind study with nine patients in two groups. The patient groups were not different in respect to the underlying cardiac disease, electrophysiologic parameters at the baseline study, or in blood pressure. Isradipine significantly decreased the systolic (p less than 0.01) and diastolic (p less than 0.05) blood pressure, while sinus cycle length decreased significantly (p less than 0.05) in the placebo group and the isradipine group with no difference between the two study groups. The influence on sinus node recovery time, effective refractory period of the av-node, intranodal conduction time, and PR interval were not significant. In conclusion, isradipine significantly decreased systolic and diastolic blood pressure. The decrease in sinus cycle length after intravenous isradipine was not significantly different from the decrease seen in the placebo group. Atrioventricular conduction was not significantly affected.

Atrioventricular Node↗
PubMed1990

[Effect of cibenzoline on atrial vulnerability and value of electrophysiological methods in the treatment of paroxysmal atrial fibrillation].

The effects of intravenous cibenzoline (1,5 mg/kg) on atrial vulnerability and electrophysiology were assessed in 25 patients with documented paroxysmal atrial fibrillation, in whom sustained (greater than 30 s) atrial fibrillation/-flutter was induced by programmed atrial stimulation. In seven patients atrial fibrillation persisted despite the application of cibenzoline; in eight patients induction of atrial fibrillation was not prevented. In 10 patients the induction of sustained atrial fibrillation was prevented by cibenzoline. Intraatrial conduction time and shortest ventricular cycle length during atrial fibrillation were increased by cibenzoline (p less than or equal to 0.01). The effective refractory period of the right atrium was not significantly affected. Eight patients with frequent episodes of paroxysmal atrial fibrillation received oral cibenzoline (320 mg/day) for control of paroxysmal atrial fibrillation irrespective of the efficacy of intravenous cibenzoline. Prevention of stimulation-induced atrial fibrillation predicted successful treatment of paroxysmal AF. In conclusion, cibenzoline might be effective in the treatment of atrial tachyarrhythmias. Programmed atrial stimulation seems to be helpful in the prediction of the efficacy of an antiarrhythmic treatment of paroxysmal atrial fibrillation.

Adult↗
PubMed1990

[Effect of acute short-term ischemia during PTCA on the function of the right ventricle].

To determine whether a transient ischemia of the right ventricle leads to right ventricular impairment and whether RV function can also be influenced by septal ischemia caused by an occlusion of the left anterior descending coronary artery (LAD), RV function before and at the end of 60 s of ischemia during PTCA was assessed in 15 patients with single-vessel disease of either the right coronary artery (RCA, n = 10) or the LAD (n = 5). The RV-enddiastolic pressure and the pulmonary capillary wedge pressure (PCW) were recorded continuously. The RV ejection fraction was determined from ventriculograms performed before and during coronary occlusion. An increase of RVEDP from 3.7 +/- 1.2 to 8.3 +/- 1.8 mm Hg (p less than or equal to 0.001) and a decrease of the RV-ejection fraction from 52 +/- 3 to 33 +/- 8% (p less than or equal to 0.001) occurred during RCA occlusion with a predominant ischemia of the RV free wall only, and not during LAD occlusion with left ventricular and septal ischemia. The extent of the RV dysfunction was independent of an additional increase of RV afterload (PCW increase). Comparable to ischemic effects on left ventricular function, an acute right ventricular myocardial ischemia results in a severe RV contractile failure.

Angioplasty, Balloon, Coronary↗
PubMed1989

Comparison of the effects of intravenous and oral betaxolol on antegrade and retrograde conduction in patients with atrioventricular nodal reentrant and atrioventricular reentrant tachycardia.

The electrophysiologic effects of intravenous (0.15 mg kg-1) and oral (20 mg day-1) betaxolol have been investigated in 11 patients with atrioventricular (A-V) nodal reentrant tachycardia and eight patients with orthodromic A-V reentrant tachycardia. Betaxolol significantly (P greater than 0.01) prolonged sinus cycle length, sinus node recovery time, intranodal conduction time, and the antegrade functional refractory period of the A-V node. When the effective refractory period of the A-V node could be determined it was increased by betaxolol, whereas no significant electrophysiologic effects were observed in the atrium, the ventricle or the accessory pathway. Intravenous betaxolol prevented tachycardia in 8 out of 11 patients with A-V nodal reentrant tachycardia, whereas oral betaxolol was effective in 10 patients, primarily by acting on the antegrade limb in two patients and on the retrograde limb in eight patients. In those with A-V reentrant tachycardia, intravenous betaxolol did not prevent tachycardia in any patient, while it was effective after oral treatment in two patients. When the tachycardia remained inducible, cycle length of the tachycardia increased in all patients, due to prolongation of the antegrade and retrograde conduction time in patients with A-V nodal reentrant tachycardia, and due to an increase in the antegrade conduction time, i.e. the A-V node, in the patients with A-V reentrant tachycardia. In conclusion, betaxolol proved to be effective in the treatment of supraventricular tachycardia; for chronic treatment, a single oral dose (20 mg) seems to suffice.

Administration, Oral↗
PubMed1989

[Successful treatment of stress-induced therapy refractory ventricular tachycardia with verapamil].

A 51-year-old woman was admitted to the hospital for further elucidation of a syncope of unknown origin and exercise-induced tachycardias with broad QRS-complex. The tachycardia was induced by bicycle exercise stress testing, had a frequency of 165/min, showed an inferior axis and left bundle branch block. Organic heart disease was excluded by right and left heart catheterization and selective coronary angiography. A nodoventricular bundle or an atrio-ventricular bundle was excluded by an extensive electrophysiologic study, therefore the documented tachycardia was probably of ventricular origin. However, it was not possible to induce a ventricular tachycardia by programmed ventricular stimulation with up to three extrastimuli even after the infusion of isoprenaline. Sotalol (2 x 160 mg/die) and the combined treatment with mexiletine (2 x 360 mg/die) and disopyramide (2 x 250 mg/die) did not prevent the induction of the tachycardia by exercise testing. The combination of sotalol and flecainide (2 x 100 mg/die) evoked complex ventricular arrhythmias at rest not noted before, and it was therefore withdrawn as well. After all antiarrhythmic drugs were withdrawn verapamil was given in a dose of 3 x 120 mg and this therapy reproduceably prevented the induction of ventricular tachycardia by exercise testing.

Anti-Arrhythmia Agents↗
PubMed1989

[Electrophysiologic properties of cibenzoline in Wolff-Parkinson-White syndrome and atrioventricular nodal reentry tachycardia].

The electrophysiologic effects of the new class-1 antiarrhythmic drug cibenzoline (1.5 mg/kg within 10 min, followed by an infusion of 0.5 mg for 30 min) were investigated in six patients with atrioventricular (av) nodal reentrant tachycardia and nine patients with atrioventricular tachycardia. Sinus cycle length, sinus node recovery time, effective refractory period (ERP) of the atrium and the ventricle as well as the ERP of the av node were not significantly affected by cibenzoline. Retrograde conduction via the av node was prevented by cibenzoline in 6/15 patients, retrograde ERP was increased in 4/15 patients and in 5/15 patients determination of the retrograde ERP of the AV node was impossible. Intranodal conduction time (AH-interval) and infranodal conduction time (HV-interval) was increased from 96 +/- 27 ms to 117 +/- 40 ms (p less than 0.01) and 36 +/- 12 ms to 62 +/- 12 ms (p less than 0.01), respectively. In four patients with antegrade conduction along the accessory pathway no antegrade conduction was seen after the application of cibenzoline. Retrograde ERP of the accessory pathway was increased in two patients, it was unchanged in three patients, and no retrograde conduction along the accessory pathway was seen in four patients. AV nodal reentrant tachycardia was not inducible, after cibenzoline in 4/6 patients and in 5/9 patients with AV reentrant tachycardia. If tachycardia remained inducible, an increase in tachycardia cycle length from 333 +/- 46 ms to 402 +/- 24 ms was observed (p less than 0.01). In conclusion the electrophysiologic effects of cibenzoline make it a suitable drug for the treatment of av nodal reentrant tachycardia and atrioventricular tachycardia.

Adult↗