Biomedical subjects
Publications and source records attributed to W Kranig.
We describe a biventricular stimulation mode to pace both ventricles with a single electrical stimulus between the tip of the left ventricular electrode and the tip of the right ventricular electrode: one ventricle is stimulated cathodal the other anodal.
Cardiac resynchronization therapy by multisite biventricular pacing presents an additive therapeutic option in the treatment of severe heart failure. Biventricular pacemaker implantation is challenging in patients with persistent left superior vena cava. We describe in this case report the implantation of a biventricular pacemaker using a left-sided approach in a patient with persistent left superior vena cava.
The following report illustrates the case of a 40-year old patient, who was transferred to our hospital because of a symptomatic sustained ventricular tachycardia (VT). The documented VT showed typical left bundle branch block morphology with an inferior axis, which was accompanied by repolarization abnormalities in the right precordial leads, as revealed by the surface ECG. While coronary angiography allowed the exclusion of an obstructive coronary heart disease and confirmed an intact left ventricular function, the right ventricular angiography as well as the MRI demonstrated not only reduced right ventricular function but also regional abnormalities of contraction in the inferior and diaphragmal regions and typical "outpouchings" and "bulgings". The MRI also provided evidence for sporadic fatty infiltrations of the right ventricle. In the electrophysiological study, sustained VT could be reproducibly induced, while showing the typical RVOT configuration, which corresponded to the clinically apparent VT. Since these examination results matched with the criteria of McKenna et al., arrhythmogenic right ventricular cardiomyopathy was diagnosed. The patient underwent implantation of a cardioverter-defibrillator (ICD) and medical treatment with metoprolol. This particular case report was selected because it shows a typical presentation of an ARVC. Furthermore, the present example offers the possibility of demonstrating that in the case of an ARVC in the regions of the right ventricle, arrhythmogenic areals can also be found which seem morphologically inconspicuous.
BACKGROUND: Gastric infection caused by Helicobacter pylori has recently been associated with increased risk of coronary artery disease. AIM: To: 1) determine seroprevalence of Helicobacter pylori and its cytotoxin associated gene A in patients with/without coronary artery disease (group A), 2) assess influence of Helicobacter pylori eradication on coronary artery lumen reduction after percutaneous coronary angioplasty (group B) and 3) determine influence of Helicobacter pylori eradication on plasma cytokines, lipids and coagulation factors in patients subjected to percutaneous coronary angioplasty (group B). PATIENTS AND METHODS: Group A included 100 patients with coronary artery disease (subgroup 1) and 100 patients without (subgroup II). For Helicobacter pylori seroprevalence, plasma anti-Helicobacter pylori and anti-cytotoxin associated gene A IgG were examined. Group B included 40 patients with significant single-vessel coronary arterial disease and Helicobacter pylori infection confirmed by 13C-urea breath test and serologically using anti-Helicobacter pylori and anti-cytotoxin associated gene A IgG. Six months after percutaneous coronary angioplasty and triple anti-Helicobacter pylori therapy, the Helicobacter pylori status reassessed by urea breath test was negative in all but two patients of subgroup I subjected to Helicobacter pylori therapy. Coronary angiography and laboratory tests were repeated in both subgroups of group B included in the trial and reduction in coronary artery lumen in these subgroups was compared to baseline after percutaneous coronary angioplasty considered as 100%. RESULTS: Helicobacter pylori seropositivity reached 81.5% of coronary artery disease (subgroup I) and was significantly higher than that in controls without coronary artery disease (subgroup II) (51%), the odds ratio being 4.3 for Helicobacter pylori in coronary artery disease. Cytotoxin associated gene A IgG detection was also significantly higher (47.3%) in coronary artery disease than in controls (28%) giving the odds ratio about 2.3. Mean coronary artery lumen reduction in patients undergoing percutaneous coronary angioplasty + Helicobacter pylori eradication therapy (subgroup I) was significantly (p<0.05) smaller compared to percutaneous coronary angioplasty + placebo-treated subgroup II (22% vs 41%). CONCLUSIONS: 1) There is a significant link between coronary artery disease and infection with Helicobacter pylori, especially expressing CagA proteins, 2) Helicobacter pylori eradication significantly attenuates reduction in coronary artery lumen in coronary artery disease patients after percutaneous coronary angioplasty possibly by elimination of chronic inflammation and decline in proinflammatory cytokine release, and 3) Infection of Chlamydia pneumoniae in these percutaneous coronary angioplasty patients is not affected by eradication therapy.
Atrial fibrillation is due to complications a frequent clinical problem. Internal cardioversion shows a high effectiveness with conversion rates from up to 85%. Aim of this study was to evaluate the influence of body weight (body-mass-index [BMI]) on the effectiveness of different cardioversion procedures.
INTRODUCTION: The therapeutical limits of drug and surgical therapy for severe chronic heart failure make the research for adjunctive treatment options necessary. After the positive effects of AV-synchronous pacemaker stimulation in patients with dilatative cardiomyopathy and 1st degree AV-block, this study was to evaluate the benefit of transient pacemaker stimulation in patients with dilated cardiomyopathy and left bundle branch block. METHODS AND PATIENTS: 19 patients (14 male, 5 female, age 60 +/- 8 yrs) were included in the study. Inclusion criteria were congestive heart failure, stage NYHA III or greater and left bundle branch block. Transient stimulation of the myocardium was applied via two electrodes (right atrium and right ventricle) in VDD mode, whereby a series of AV-delay-times between 80 and 180 ms was tested. Thermodilution was used to determine cardiac output, pulmonary capillary pressure and pulmonary arterial pressure. RESULTS: In 16 patients, pacemaker stimulation led to a significant increase of cardiac output (3.8 +/- 0.5 l/min to 4.6 +/- 0.5 l/min; p < 0.002), cardiac index (1.90 +/- 0.20 l/min/m2 to 2.3 +/- 0.2 l/min/m2; p < 0.002) and of stroke volume (51 +/- 8 ml to 62 +/- 6 ml; p < 0.002) as well as a significant reduction of mean pulmonary capillary pressure (19 +/- 1 mmHg to 15 +/- 1 mmHg; p < 0.01). The mean pulmonary arterial pressure remained unchanged. Three patients did not benefit from the treatment. CONCLUSION: AV-sequential pacemaker-stimulation (right ventricular electrode placement) can be a valuable adjunctive therapy in selected patients with late stage congestive heart failure and left bundle branch block.
BACKGROUND AND OBJECTIVE: Because there are limits to the drug treatment or surgical intervention of advanced heart failure, alternative methods are being explored. It was the aim of this study to investigate the extent to which optimal atrioventricular (AV) sequence of dual pacemaker stimulation in patients with advanced dilated cardiomyopathy (DCM) of different aetiology increases their usually much reduced cardiac output. PATIENTS AND METHODS: The study group consisted of 22 patients (five women, 17 men; aged 54-84 years) with heart failure in class I-IV (New York Heart Association classification). Temporary dual electrode stimulations (in the right atrium and ventricle) in the VDD or DDD mode were performed with programmed AV intervals between 80 and 180 ms. Cardiac output (CO), pulmonary capillary and pulmonary arterial pressures were measured via an indwelling catheter. RESULTS: In 17 patients with a 1 degree AV block and/or left bundle branch block in the surface ECG pacing produced a significant increase in CO (from 3.7 +/- 0.75 to 4.6 +/- 0.65 l/min; P < 0.005) and cardiac index (from 2.05 +/- 0.43 to 2.47 +/- 0.37 l/min/m2; P < 0.005). There was no increase in patients with normal PR interval and QRS duration. Mean pulmonary capillary and pulmonary arterial pressures remained unchanged. CONCLUSION: Alteration of AV sequence by pacemaker in selected patients in the late stage of heart failure, particularly if there is also abnormal atrioventricular and/or intraventricular conduction delay, may be an effective complementary method of treatment.
Noise from low-altitude military flights differs from most other sources of noise by virtue of its unpredictability in space and time, its very high maximal levels, and the fast increase in noise level at high flight speeds. While this makes low-altitude flights a frightening and annoying experience, the potential immediate health hazards for exposed individuals with preexisting cardiovascular disease are unclear. A field study on the immediate effects of exposure to low-altitude flights on heart rate and arrhythmia was conducted among patients of a rehabilitation clinic for cardiac diseases in the summer of 1990 in Bad Rothenfelde, Germany. Twenty-four hour electrocardiograms of 68 patients taken on days when low-altitude overflights with peak sound pressure levels above 95 dB(A) were registered on the flat roof of the clinic were analyzed for changes in the heart rate or the occurrence of ventricular extrasystoles in four 2-min periods before, around, and after the overflights. Overall, 149 "overflight events" were included in the analysis. No major changes in the heart rate or in the frequency of ventricular extrasystoles were observed, but this could be partly due to problems inherent in the field approach. Nevertheless, the potential effects on heart rate and arrhythmia of low-altitude flights appear to be of limited magnitude compared to the potential effects of other factors, such as psychological or physical exposures, and they are probably too small to be proven under field conditions in an observational epidemiologic study in Germany following the limitations placed on the frequency and altitude of flights in September 1990.