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Herzschrittmachertherapie.80090006.eng.abstr
|
Herzschrittmachertherapie.80090006.eng.abstr
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[
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"text": [
"In patients with coronary artery disease , it is controversial whether cardiac arrhythmias result from acute subendocardial ischemia . The aim of this study was to analyze the relationship between myocardial ischemia and ventricular arrhythmia ."
],
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0,
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]
}
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[] |
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Herzschrittmachertherapie.80090015.eng.abstr
|
Herzschrittmachertherapie.80090015.eng.abstr
|
[
{
"id": "Herzschrittmachertherapie.80090015.eng.abstr-passage-0",
"type": "abstract",
"text": [
"In patients with sustained ventricular tachycardia after myocardial infarction , late potentials are often constantly present in the signal-averaged electrocardiogram . After myocardial infarction and ventricular fibrillation , late potentials are not constant in many cases . However , these patients show functional changes of late potentials during acute ischemia during PTCA or during heart rate acceleration due to atrial pacing . Use of selective signal-averaging late potential analysis during exercise is possible . Exercise tests can provoke ischemia and heart rate acceleration . The Holter ECG allows the detection of functional changes during daily life activity . Initial studies indicated that patients with dilatative cardiomyopathyprone to ventricular tachycardia might be identified with greater sensitivity . The results show that late potentials can be provoked especially in patients with ventricular fibrillation or fast ventricular tachycardia and no late potential at rest . Functional late potential analysis might improve risk stratification in patients prone to sudden death and ventricular arrhythmias ."
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[] |
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Herzschrittmachertherapie.80090026.eng.abstr
|
Herzschrittmachertherapie.80090026.eng.abstr
|
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0,
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[] |
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Herzschrittmachertherapie.80090030.eng.abstr
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Herzschrittmachertherapie.80090030.eng.abstr
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[
{
"id": "Herzschrittmachertherapie.80090030.eng.abstr-passage-0",
"type": "abstract",
"text": [
"Reports from the literature show that Holter monitoring is more sensitive in detecting pacemaker dysfunction than 12-lead ECG . Holter monitoring is , therefore , an additional useful tool in the pacemaker follow-up clinic . Data from the literature show that pacemaker dysfunctions are more frequent than patients ' history and common standard techniques of the pacemaker follow-up clinic may suggest . All patients , therefore , should undergo Holter monitoring during follow-up . The following indications for Holter monitoring in pacemaker patients are commonly accepted : detection of pacemaker dysfunctions or spontaneous arrhythmias in symptomatic patients , surveillance of asymptomatic patients at least after implantation of complex multiprogrammable pacemakers , assessment of spontaneous heart rate in pacemaker patients , and sensor function in rate adaptive pacemakers . In patients with dual-chamber pacemakers Holter monitoring is useful in detecting atrial arrhythmias , especially atrial fibrillation affecting adequate pacemaker function , and pacemaker-mediated tachycardias . Diagnostic sensitivity of Holter monitoring in detecting transient pacemaker dysfunctions can be further improved by computer-aided analysis , which is still limited to the evaluation of ventricular inhibited demand pacemakers . In many cases only visual analysis is possible . The prognostic value of transient pacemaker dysfunctions detected by Holter monitoring should be clarified by long-term follow-up studies ."
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Herzschrittmachertherapie.80090042.eng.abstr
|
Herzschrittmachertherapie.80090042.eng.abstr
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[
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"id": "Herzschrittmachertherapie.80090042.eng.abstr-passage-0",
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[] |
[] |
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Herzschrittmachertherapie.80090053.eng.abstr
|
Herzschrittmachertherapie.80090053.eng.abstr
|
[
{
"id": "Herzschrittmachertherapie.80090053.eng.abstr-passage-0",
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"To date there are not enough data concerning the prognostic value of dynamic QT analysis for malignant arrhythmic events after acute myocardial infarction . It was the to investigate , whether such patients have a different behavior of dynamic QT intervals in comparison to an identical group without arrhythmic events . In a prospective study , 239 consecutive patients after thrombolytic and if necessary interventional therapy for acute myocardial infarction were followed for 1100+/-303 days . Eight patients suffered an arrhythmic event ( sudden cardiac death : 6 patients , sustained ventricular tachycardia : 2 patients ) during follow-up . These patients were matched to 8 patients without arrhythmic event who were comparable concerning age , gender , site and former incidence of infarction , duration until start of lysis , peak level of CPK release , and LV-ejection fraction ( matched pairs ) . All patients had 24 hour Holter ECG recordings 27+/-3 days after acute myocardial infarction . Dynamic beat-to-beat QT interval analysis was performed by using a commercially available system ( Pathfinder 700 , Reynolds Medical , Hertford , UK ) . Following parameters were compared : mean and beat-to-beat standard deviation of all QT intervals to the end of the T wave , mean and beat-to-beat standard deviation of all QT intervals to the apex of the T wave , as well as these values corrected for heart rate ( Bazett's formula ) . Comparing the two groups , there were no significant differences concerning all investigated parameters . In this study , the parameters of dynamic QT analysis could not discriminate the investigated population of patients after acute myocardial infarction with arrythmic event from those without arrhythmic event . Whether the analysis of dynamic QT dispersion over 24 hours by using a multiple lead configuration could be useful for a better identification of patients at risk for sudden cardiac death remains to be evaluated by further studies ."
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Herzschrittmachertherapie.80090070.eng.abstr
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Herzschrittmachertherapie.80090070.eng.abstr
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"Atrial tachyarrhythmias significantly reduce quality of life in a surprisingly large number of patients . The safe and effective treatment of atrial tachyarrhythmias is being intensively studied . Internal electrical cardioversion of atrial fibrillation has been shown to be an effective non-pharmacological treatment option . Cardioversion therapy has been applied in the absence of a clear understanding of the mechanisms governing the process . Recent measurements of atrial transmembrane potentials using sophisticated optical mapping techniques reveal that internal cardioversion shocks cause changes in repolarization time that favor annihilation of wave fronts . Thus , mechanisms of atrial cardioversion appear to be similar to ventricular defibrillation . Further studies are needed to determine whether cardioversion mechanisms differ for chronic atrial fibrillation compared to acute atrial fibrillation ."
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Herzschrittmachertherapie.80090076.eng.abstr
|
Herzschrittmachertherapie.80090076.eng.abstr
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"Over the past 5-7 years , there has been a renewed research interest into the mechanism as well as the development of newer \" emerging \" treatment modalities for atrial fibrillation . One of these novel therapies is the implantable atrial defibrillator . In this article we will review the basic and clinical research which has been used in the development of electrode systems and shock waveforms utilized by commercially-available implantable atrial cardioversion devices ."
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[] |
[] |
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Herzschrittmachertherapie.80090083.eng.abstr
|
Herzschrittmachertherapie.80090083.eng.abstr
|
[
{
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"This review summarizes the results of internal cardioversion of atrial fibrillation in comparison to external cardioversion . Internal cardioversion was achieved by positioning defibrillation electrodes in the right atrium and coronary sinus ( alternatively in the left pulmonary artery ) . In previous studies also a combined internal/external cardioversion was used by locating a defibrillation electrode in the right atrium together with a cutaneous patch electrode . Although in comparative studies the success rate of 91-93% with internal cardioversion is higher compared to success rates of 67-79% with external cardioversion , the conventional method of external cardioversion remains the method of first choice . The success rate of internal cardioversion after failed external cardioversion ranges from 73 to over 90% . Possible indications for primary internal cardioversion are : induced atrial fibrillation during electrophysiological studies , atrial fibrillation after cardiothoracic surgery and cardioversion of atrial fibrillation in patients with permanent pacemaker implants ."
],
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[] |
[] |
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Herzschrittmachertherapie.80090094.eng.abstr
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Herzschrittmachertherapie.80090094.eng.abstr
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[
{
"id": "Herzschrittmachertherapie.80090094.eng.abstr-passage-0",
"type": "abstract",
"text": [
"The promising results achieved with internal atrial defibrillation have facilitated the development of an implantable atrial defibrillator . For any new therapy , it is imperative to demonstrate safety , efficacy , tolerability with improvement in quality of life , and cost-effectiveness compared to already available therapeutic options . Most importantly , the efficacy and safety rates with a new therapy should be better or at least as good than those observed with previously available means . Maintenance of sinus rhythm or prolonged duration in arrhythmia-free intervals should be clearly demonstrated with an implantable atrial defibrillator , the MetrixTM system . Recently , a new dual-chamber defibrillator ( 7250 Jewel AF AMD ) has entered clinical evaluation . The most important new features of the 7250 AMD system include : dual-chamber pacing , a new dual-chamber detection criterion for rejection of supraventricular tachycardias , detection and treatment modalities of atrial arrhythmias , prevention strategies for atrial arrhythmias . The dual-chamber detection criterion is constantly monitoring the rhythm in the ventricle as well as in the atrium . This new dual-chamber detection algorithm is used to improve discrimination of ventricular tachycardia from supraventricular tachycardia by applying pattern recognition methods based on different P-wave positions within RR sequences . The detection algorithm can be used to withhold inappropriate ventricular therapies . Initial clinical experience with the MetrixTM system indicates stable atrial defibrillation thresholds , appropriate R-wave synchronization markers , no shock induced ventricular proarrhythmia , and excellent detection of atrial fibrillation with a specificity of 100% . Ventricular proarrhythmia has not been reported for correctly R-wave synchronized low energy shocks when closely coupled RR intervals and long-short cycles are avoided . The first results with the 7250 Jewel AF device suggest a high sensitivity for induced ventricular tachyarrhythmias and an increased specificity for reduction of inappropriate therapies ."
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Herzschrittmachertherapie.80090108.eng.abstr
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Herzschrittmachertherapie.80090108.eng.abstr
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"State-of-the-art dual chamber pacing systems feature special functions such as automatic mode switching ( AMS ) . The mode switch is based on different algorithms depending on the manufacturer . This report describes the Pacesetter Trilogy DR+ pacemaker mode switch algorithm and the mode switching activating indications by means of examples . With the Pacesetter Trilogy DR+ pacemaker , mode switch does not occur from one beat to to the next but requires several cycles . The switching from the DDD ( R ) to the DDI ( R ) mode occurs when the preset atrial tachycardia detection rate ( ADTR ) is exceeded . A prerequisite for the mode switching is the activation of a monitoring function in the pacemaker that allows the detection of atrial activity even within the post-ventricular atrial refractory period ( PVARP ) . Especially patients with stable atrial flutter require a short PVARP and a low upper rate for the monitoring function to be activated . Depending on the ADTR setting or the difference betweeen maximum tracking rate and ADTR , a slow or a fast mode switch can be reached . The smaller the difference - the minimum is 20/min the faster the mode switch and vice versa . The switch-back to the atrial tracking mode , from DDI ( R ) to DDD ( R ) , occurs when the atrial tachycardia rate drops below the programmed maximum tracking rate . The higher the maximum tracking rate , the faster the switch-back . It is especially important to keep this in mind for patients with atrial fibrillation and intermittent atrial undersensing , since due to the lack of intermittent atrial sensing , the switch-back can occur too fast or provoke mode oscillation . The event and mode switch histrogram gives information on the number of mode switches , the duration of each mode switch , and the highest atrial rate attained . Therefore , not only the switch function ca be checked but also the further development of the atrial arrhythmia and the result of an antiarrhythmic therapy . A prerequisite for the adequate function of the mode switch is the correct sensing of atrial signals during the tachyarrhythmia . The intraoperative P-wave measurement does not allow a prediction on the tachyarrhythmic atrial signal ( atrial fibrillation ) . Thus , it is desirable to program a vey high ( maximum ) atrial sensitivity which in turn requires the use of bipolar leads . Potential mode switch problems such as inadequate , false or no activation of the mode switch function , and mode oscillation can be minimized through correct pacemaker programming . It has to be determined which patient requires a mode switch or will profit from this feature and which patient will be better off with a DDI ( R ) mode right from the start because it is still true : the more algorithms , the more complex the pacemaker ECG assessment , and the longer the patient follow-up ."
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Herzschrittmachertherapie.80090120.eng.abstr
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Herzschrittmachertherapie.80090120.eng.abstr
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"The opportunity to treat a patient with a single-lead-VDD stimulation demands a new approach to the routine pacemaker therapy . It was the aim of the study to take a look at the specific problems and complications that occur during the use of the single-lead-VDD stimulation in all appropriate cases without special preoperative diagnostic steps . Beside that we studied the influence of the recently established single-lead-VDD stimulation on the other modes of stimulation in all patients who were in need for a pacemaker . We analysed the number of all implantations done by us from 1991 until 1996 , in 1991 and 1992 without , from 1994 to 1996 with VDD stimulation . We looked for the problems of VDD stimulation in a follow-up period of at least 9 months . During the studied period the percentage of patients with AV-block remained nearly the same . From 1994 to 1996 we did 206 VDD implantations , this are 25.5% of all first time implantations . The percentage of AAI- and DDD-pacemakers remained more or less the same , whereas VVI implantations decreased from 72.2% in 1991 and 1992 to 43.3% from 1994 to 1996. In 17 cases the minimal intraoperative atrial potentials were less than 0.5mV , but only 2 of these patients showed a loss of atrial sensing later . All together we could prove intermittend atrial sensing loss in 11 ( 5.3% ) patients out of 206 , 6 ( 2.9% ) of them were clinically symptomatic but without the necessity of an operative correction . A second operation had to be performed in 6 cases , in 4 of them caused by the special electrode or mode ( ventricular loss of capture in 3 cases and severe sick sinus syndrome in 1 case ) . 12 patients showed atrial fibrillation in the follow-up . 3 patients were only programmed to VVI mode , but in 9 of them the atrial fibrillation could be terminated by drugs . The single-lead-VDD therapy proved to be very practicable and effective inspite of its specific problems and compromises . Because of its physiological way of stimulation for more patients this therapy produces a remarkable improvement in the possibilities of the pacemaker therapy ."
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[] |
[] |
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] |
Herzschrittmachertherapie.80090127.eng.abstr
|
Herzschrittmachertherapie.80090127.eng.abstr
|
[
{
"id": "Herzschrittmachertherapie.80090127.eng.abstr-passage-0",
"type": "abstract",
"text": [
"AV-synchrony and rate-responsive pacing are known as major factors to increase the maximum working capacity in patients with chronotropic incompetence . However , their importance throughout low-levels of exercise is poorly evaluated . We studied 11 patients with implanted dual-chamber pacemakers ( Telectronics , META 1254 ) concerning oxygen uptake kinetics during serial treadmill exercise testing at a constant workload of 35 W ( LITE protocol ) . Each patient was tested in VVIR- , DDD- , and DDDR-mode . All AV delays were constant at 160ms . The oxygen deficit ( O2D), mean response time ( MRT ) for oxygen uptake , and a oxygen deficit index ( O2Di) were determined . In addition , the heart rate ( HR ) and bloodpressure were monitored . Results : Significant differences ( p 0.01 ) were observed in HR and O2D when comparing both DDD- to VVIR- and DDD- to DDDR-modes . Comparing the randomly synchronous VVIR- to the DDDR-mode , only the MRT of oxygen uptake demonstrated a significant decrease in the DDDR-mode ( p 0.05 ) . There were also significant decreases in O2Di and MRT in the DDDR-mode , as compared to the non-rate responsive DDD-mode ( p 0.01 ) . Stress testing in PM patients with an appropriate chronotropic response to low intensity exercise demontrates that AV synchrony is of much less influence on oxygen uptake kinetics than the rate-adaptive pacing ."
],
"offsets": [
[
0,
1381
]
]
}
] |
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] |
Herzschrittmachertherapie.80090134.eng.abstr
|
Herzschrittmachertherapie.80090134.eng.abstr
|
[
{
"id": "Herzschrittmachertherapie.80090134.eng.abstr-passage-0",
"type": "abstract",
"text": [
"A 67year-old man with known coronary artery disease presented with an episode of wide QRS tachycardia with left bundle branch block ( LBBB ) morphology associated with dyspnea , angina and near syncope which terminated spontaneously on arrival in the emergency room . The differential diagnosis consisted of ( 1 ) ventricular tachycardia or ( 2 ) supraventricular tachycardia with either aberrant conduction or anterograde conduction via an accessory connection . During invasive electrophysiologic testing , programmed ventricular stimulation reproducibly induced the clinical tachycardia with LBBB morphology and a cycle length of 342ms . Retrograde conduction via a concealed left-sided accessory connection was confirmed . During tachycardia , sensed ventricular extrastimulation induced a sudden increase in tachycardia cycle length associated with loss of LBBB . This ( paradoxical ) increase in tachycardia cycle length with loss of ipsilateral bundle branch block during orthodromic AV reentrant tachycardia was due to the additional presence of dual AV node physiology and switch from anterograde fast to anterograde slow pathway conduction . The LBBB was most likely due to the `linking phenomenon ' which was interrupted by the right ventricular extrastimulus . The accessory connection was successfully ablated within the proximal coronary sinus , and typical or atypical AV node reentry could not be induced . Thus , slow pathway ablation was not performed ."
],
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[
0,
1471
]
]
}
] |
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[] |
[] |
[
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] |
Herzschrittmachertherapie.80090147.eng.abstr
|
Herzschrittmachertherapie.80090147.eng.abstr
|
[
{
"id": "Herzschrittmachertherapie.80090147.eng.abstr-passage-0",
"type": "abstract",
"text": [
"Arrhythmogenic right ventricular cardiomyopathy ( ARVC ) is a primary heart muscle disease characterized by progressive myocardial atrophy of the right ventricle , with massive fibro-fatty replacement accounting for ventricular electrical instability at risk of severe arrhythmias or even cardiac arrest . The disease was found to be the major cause of sudden death in the young and athlete in the Veneto region , Italy . A familial occurrence with autosomal dominant inheritance was then discovered and the prevalence estimated to be higher than 1 in 5000. Linkage analysis allowed to identify four loci , two mapping to chromosome 14 , one to chromosome 1 and one to chromosome 2 , suggesting genetic and clinical heterogeneity . The specific gene defects as well as the defective coded proteins have not yet been identified . ARVC was recently included among the cardiomyopathies in the revised WHO classification . Both the etiology and pathogenesis of the disease are still unknown . In particular , the mechanisms leading to progressive loss of myocardium and fibro-fatty replacement are speculative . According to the frequent finding of inflammatory infiltrates at histology , an inflammatory theory has been advanced and infective , toxic or immune mechanisms have been postulated . Recently , myocyte programmed cell death ( apoptosis ) has been demonstrated both in autoptic and bioptic material , suggesting that recurrent bouts of apoptosis may destroy the myocardium , which is then replaced by fibro-fatty tissue . This evidence may open new avenues not only to understand the disease but also to conceive new diagnostic and therapeutic strategies ."
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] |
[] |
[] |
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Herzschrittmachertherapie.80090155.eng.abstr
|
Herzschrittmachertherapie.80090155.eng.abstr
|
[
{
"id": "Herzschrittmachertherapie.80090155.eng.abstr-passage-0",
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"text": [
"In the syndrome arrhythmogenic right ventricular dysplasia cardiomyopathy , little is known to date about the mechanism for the development of arrhythmias . In a group of 54 patients with documented ventricular tachycardia during longterm ECG recordings , the determinants for the development of VT and the relationship between signal-averaged ECG and the morphological characteristics of the disease are investigated . The analysis of the long-term electrocardiographic data includes the measurement of RR-intervals 30 , 15 , 5 , 1min and immediately before onset of the VT , the determination of the morphology of the previous ventricular premature beats , and the frequency of the atrial arrhythmias . Normal values for the analysis of late potentials in the ECG signal accquisition with bidirectional filters between 40 and 300Hz were defined a maximum of 113ms for a QRS width , LAS of 38ms , and RMS40 of 16uV . The analysis of the long-term ECG produced monomorphic VT in all cases without previous atrial arrhythmia and in only 4 cases with previous polymorphic ventricular premature beats . A long-short phenomenon could only be proven in 4VT episodes . In 84% of all tachycardias , no arrhythmia were found immediately before onset of the arrhythmic event . According to the circadian clock , two peaks , mornings between 6 and 9h and evenings between 6 and 9h , could be determined . In patients , who were recently diagnosed with ARVD , a significant shortening of the RR intervals before the onset of VT as an indication of an acceleration of the sinus rhythm was observed . This effect could not be observed in patients with a past medical history of AVRD . Late potentials were determined with a prevalence of 74% overall . Increasingly , late potentials were observed with morphologically diffuse forms of the ARVD . A correlation to the severity of spontaneous arrhythmias ( ventricular , sustained or not sustained VT ) could not be established . In comparison to the origin of VT in coronary heart disease , previous arrhythmias play a less important role in arrhymogenic right ventricular dysplasia cardiomyopathy . Most importantly , an intensified sympathetic tone before onset of VT and an increased prevalence of positive late potentials are observed ."
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"Besides autopsy determined findings of a fibro-fatty replacement in the right ventricular myocardium , no assured clinical evidence of arrhythmogenie right ventricular dysplasia-cardiomyopathy ( ARVD ) exists yet . Criteria for the clinical diagnosis of AVRD were complied in 1994 by members of the ISFC work group and the European Association for Cardiology . These criteria include structural , functional , histological , and electrophysiological abnormalities , which were divided into major and minor criteria . With the successive examination of a collective of 24 patients with a histologically determined diagnosis of ARVD at the Jean Rostand Hospital in Ivry-sur-Seien , France , the value of the complied criteria were checked . Global or segmental dilatation of the right ventricle in the sense of major criteria could be proven in 20 patients ( 83% ) using angiography or electrocardiography . Four patients ( 16% ) exhibited only minor criteria in the radionuclear angioscintigraphy or right ventricular angiography in the form of segmental kinetic disturbances of the right ventricular . In all patients , the typical fibrofatty replacement in the right ventricular myocardium could be histologically determined . T-inversion in the right precordial leads were present in 17 patients ( 71% ) . A localized QRS-widening of more than 110ms in V1 to V3 in 8 patients ( 33% ) and an epsilon wave in 6 patients ( 25% ) were observed as major criteria . A late potential analysis using signal averaged ECG was only present in 8 patients with positive results in 4 cases ( 50% ) in the sense of minor criteria . Left bundle branch block ventricular tachycardia , which was classified as a minor criterion , was observed in 23 patients ( 96% ) ; only one patient died without proven arrhythmia from rapidly progressing heart failure . A previous history of unexpected sudden death in family members as a minor criterion arose in 3 of 19 patients ( 15% ) . The complied task force criteria for the diagnosis of AVRD led in all 24 cases to the diagnosis of the disease , whereby the value of a determined histological diagnosis was the gold standard . Without inclusion of histological data , the clinical diagnosis was determined in only 10 cases . The question remains whether with a simple division of findings into major and minor criteria a pure clinical diagnosis is possible ."
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] |
[] |
[] |
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Herzschrittmachertherapie.80090169.eng.abstr
|
Herzschrittmachertherapie.80090169.eng.abstr
|
[
{
"id": "Herzschrittmachertherapie.80090169.eng.abstr-passage-0",
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"Arrhythmogenic right ventricular cardiomyopathy ( ARVCM ) is a frequent underlying disease in young patients with ventricular tachycardia ( VT ) and sudden death . Treatment is frequently indicated and is mainly directed at the prevention of ventricular tachyarrhythmias and sudden death . In a minority of patients with progressive ARVCM and clinical signs of heart failure , pharmacological treatment with vasodilators , diuretics , and digitalis may be required ."
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0,
466
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]
}
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[] |
[] |
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Herzschrittmachertherapie.80090197.eng.abstr
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Herzschrittmachertherapie.80090197.eng.abstr
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"This paper reviews the recent literature concerning the prevalence and prognostic significance of arrhythmias occurring during exercise testing . Supraventricular arrhythmias can occasionally be found during exercise testing in apparently healthy individuals . Even supraventricular tachycardias do not portend increased cardiovascular mortality or cardiac events . In patients with heart disease exercise induced supraventricular arrhythmias are seen more frequently . Ventricular premature beats during exercise testing are frequent findings in healthy individuals as well as in patients with heart disease . In patients with coronary heart disease , they are associated with exercise induced ischemia . In patients with coronary heart disease , especially in postmyocardial infarction patients , frequent ventricular premature beats , couplets and ventricular tachycardia provide independent prognostic information beyond that provided by other diagnostic tools . Especially patients with complex ventricular arrhythmias , low maximum work load , and low maximum systolic blood pressure during exercise have an increased risk of major cardiac events and cardiac mortality . Ventricular premature beats that disappear or decrease during exercise have the same prognostic value as arrhythmias that are exercise induced or show increased frequency during exercise testing ."
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Herzschrittmachertherapie.80090203.eng.abstr
|
Herzschrittmachertherapie.80090203.eng.abstr
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[
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"There is growing interest in repolarization disturbances for risk stratification of patients after acute myocardial infarction . The QT interval is subject to a variety of influencing factors , of which heart rate , sympathetic and parasympathetic tone , different drugs , and electrolyte imbalances play a major role . QT interval measurement is not standardized regarding the standard ECG lead to measure and the number of measured QT intervals . There are different T-wave morphologies in the standard ECG leads , which often make correct determination of the end of the T-wave rather difficult . Only little information exists about reference values of QT interval duration in healthy subjects , which show age- and gender-dependent differences . Moreover , some studies showed that QT interval duration is changing with time . Apart from the congenital long QT syndrome there is major interest in the acquired long QT syndromes , which are primarily drug induced , and in the value of QT interval prolongation in predicting sudden cardiac death and life-threatening arrhythmias in patients after acute myocardial infarction . Some epidemiologic studies demonstrated only a limited prognostic value of QT interval prolongation . On the other hand , several studies revealed a significant relationship between QT interval prolongation and the occurrence of life-threatening arrhythmias in the early postinfarction period . The value of QT interval prolongation predicting long-term prognosis in patients after acute myocardial infarction is not clearly evident in different studies and needs further investigation ."
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}
] |
Herzschrittmachertherapie.80090212.eng.abstr
|
Herzschrittmachertherapie.80090212.eng.abstr
|
[
{
"id": "Herzschrittmachertherapie.80090212.eng.abstr-passage-0",
"type": "abstract",
"text": [
"The description of heart rate variability ( HRV ) by statistical and spectral parameters is a problem not yet satisfactorally solved . Methods of the fractal geometry might provide some advantages because not only the length of RR-intervals ( RRI ) but the information derived from the order of RRI is considered . This method is expected to allow differentiation between chance and deterministic chaotic behavior . Hence , we developed techniques for the description of HRV by means of dimension analysis . The course of information dimension ( ID ) over 24h in 20 healthy probands was estimated from a digital holter monitor recording ( sampling rate 1000Hz , holter recorder FD3 Oxford Instruments ) . For that we calculated ID from a time window of 2500 RRI for the embedding dimension 2 up to 6. The analysis window was subsequently moved forward along a time axis in steps of 1000 RRI . The graphical reproduction of ID courses over 24h showed irregularly alternating phases of chance and deterministic chaotic behavior during the day . Conversely during the night two different patterns were demonstrated : either a persistant phase of increased chance or a period of deterministic chaotic behavior predominated . A significant correlation neither with heart rate nor with other collected or calculated data could be shown . Our method is able to asses ID over time as well as with increasing embedding dimensions . So beside statistical and spectral parameters there is a further new tool for HRV description available . Following studies have to elucidate clinical aspects ."
],
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[
0,
1583
]
]
}
] |
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"heart"
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[
19,
24
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19,
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"Methods"
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"fractal"
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}
] |
[] |
[] |
[
{
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},
{
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{
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"normalized": []
}
] |
Herzschrittmachertherapie.80090223.eng.abstr
|
Herzschrittmachertherapie.80090223.eng.abstr
|
[
{
"id": "Herzschrittmachertherapie.80090223.eng.abstr-passage-0",
"type": "abstract",
"text": [
"Catheter ablation by means of radiofrequency energy ( RF ) is an established method in the treatment of various forms of supraventricular and atrioventricular tachycardias . In patients with ventricular tachycardia ( VT ) , the success of catheter ablation depends on the pathophysiological mechanism of the arrhythmia and on the underlying heart disease ."
],
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[
0,
356
]
]
}
] |
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}
] |
[] |
[] |
[
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{
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{
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Herzschrittmachertherapie.80090234.eng.abstr
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Herzschrittmachertherapie.80090234.eng.abstr
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"VDD single-lead systems use floating ring electrodes for atrial sensing . To ensure an optimal atrial sensing function , knowledge of the interactions between electrode design , pacemaker , amplifier and implantation technique is required . In this overview , technical determinants of atrial sensing concerning atrial ring configuration ( surface area , ring spacing , full/half ring ) , design of the lead ( insulation material , conductor coil configuration ) , and amplifier design ( differential amplifier , sensing impedance , bandpass filter ) shall be explained and related to determinants at implant ( AV distance , site of implantation , atrial position , intraoperative measurement technique ) . ( 1 ) Ring configuration : Bipolar atrial full ring systems have proved to be efficient with narrow ( 5-10mm) or wide ( 15-30mm) ring spacing , as well as bipolar half ring systems with DAB configuration and narrow ring spacing . Especially in a position close to the atrial wall , a wide ring spacing detects a less clear-cut signal than a short ring spacing ; on the other hand , with a wide ring spacing , sensing is less compromised if the rings move to a worse position further away from the wall . A narrow ring spacing detects a sharper signal if positioned close to the atrial wall , but a considerable reduction of sensed P wave amplitude may result if it moves away from the wall or to an oblique angle relative to the atrial depolarization front . ( 2 ) Design of the lead : Polyurethane as insulation material provides a higher stiffness than silicone insulation . A coaxial conductor configuration increases stiffness and consequently the possibility to manipulate the atrial part of the lead . Thus , if a position close to the atrial wall is desired , the combination of a coaxial conductor coil , polyurethane insulation , and a narrow ring spacing seems most promising . ( 3 ) Amplifier design : For atrial sensing in VDD systems , bipolar sensing , differential amplifier , high sensing impedance ( > =2k), and a wide bandpass filter ( e.g. , 10-100Hz) should be realized . Especially the inclusion of a relatively low frequency range ( 10-40Hz) is important , because compared to a fixed atrial electrode , a higher quantity of the atrial signal sensed by a floating electrode is in the low-frequency range . ( 4 ) Implantation : To choose the best fitting electrode , a preoperative assessment of the size of the right cardiac cavities should be performed . A position of the ring electrodes in the mid-to-high right atrium parallel to the lateral wall should be the goal . Correct interpretation of the sensed P wave amplitude and prediction of sufficient sensing after connection with the pacemaker is only possible with exact knowledge of the measurement technique of the intraoperative pacing system analyzer and the connected permanent pacemaker device ( bandpass filter , signal peak-to baseline or peak-to-peak ) . Attention should be paid to the fixation of the electrode at the site of insertion to avoid postoperative dislocation of the ring electrodes . Knowledge of different electrode/pacemaker specific parameters and special aspects at implantation is a prerequisite for optimal function of VDD single-lead systems . Preoperatively , considerations should concern the choice of the electrode ( AV distance , ring spacing ) and implantation strategy ( position close to or rather apart from the atrial wall ) . An atrial position may only be accepted if sufficient sensing can be documented with a measuring method similar to that of the implanted pacemaker ."
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}
] |
Herzschrittmachertherapie.80090248.eng.abstr
|
Herzschrittmachertherapie.80090248.eng.abstr
|
[
{
"id": "Herzschrittmachertherapie.80090248.eng.abstr-passage-0",
"type": "abstract",
"text": [
"The presentation of the MADIT trial has raised expectations that extended use of fully sequential designs may reduce the duration of clinical trials substantially . On the other hand , AVID and CABG-Patch used group sequential designs that did not reduce trial duration to the same extent . Are sequential designs useful ? Which criteria should be applied for the choice of design ? Comparison of the biometrical characteristics of the designs . Fully sequential triangular plans reduce study durations to the maximal extent . The prices to be paid are high-standard logistics , difficulties in quality management and reduced lucidity of the presentations . Fully sequential designs should only be used for the efficacy proof of a striking new therapy if a precise estimate of the amount of benefit is not required . If , on the other hand , the focus is on clinical background , validation or positioning of the new therapy or indication , fixed sample size or moderate group sequential plans are to be preferred ."
],
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[
0,
1015
]
]
}
] |
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] |
[] |
[] |
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}
] |
Herzschrittmachertherapie.80090255.eng.abstr
|
Herzschrittmachertherapie.80090255.eng.abstr
|
[
{
"id": "Herzschrittmachertherapie.80090255.eng.abstr-passage-0",
"type": "abstract",
"text": [
"Elderly patients with known episodes of atrial arrhythmia and indication to pacemaker therapy are borderline cases relative to selection of ventricular single-chamber or dual-chamber pacemaker . The frequency of recurrence of arrhythmic episodes under dual-chamber pacemaker therapy is there the most important criterion . The differences between patients prone to paroxysmal atrial tachyarrhythmia ( atrial fibrillation or atrial flutter ) and patients without atrial tachyarrhythmia in their medical history were investigated . Frequency of recurrence of atrial fibrillation/flutter and the rate of successful therapy after implantation of a dual chamber pacemaker were studied . The long-term history of 39 patients with known intermittent or durably successfully treated episodes of atrial fibrillation/flutter was compared with 24 patients with new atrial tachyarrhythmia after pacemaker implantation . There was no significant difference in the frequency of recurrence and in therapy efficiency of atrial tachyarrhythmia between both groups . The results show the benefit of implanting a dual chamber pacemaker also for patients with a known history of atrial tachyarrhythmia . It therefore , should be postulated for therapy of those patients ."
],
"offsets": [
[
0,
1251
]
]
}
] |
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Herzschrittmachertherapie.80090260.eng.abstr
|
Herzschrittmachertherapie.80090260.eng.abstr
|
[
{
"id": "Herzschrittmachertherapie.80090260.eng.abstr-passage-0",
"type": "abstract",
"text": [
"In patients with DDD pacing systems , optimal AV delay is mainly determined by interindividually differing interatrial conduction time . If the latter is measured , individual optimal AV delay in VDD and DDD operation can be approximated by adding a representative , optimal interval of 70ms between left atrial depolarization and ventricular stimulus . In modern pacemakers providing telemetry , combination of right atrial telemetry and left atrial electrography via an esophageal lead could be used to measure interatrial conduction times for individual AV delay programming . 1. To test the usefulness of telemetric right atrial electrograms and markers as a right atrial measuring reference . 2. To prove the possibility of implementing left atrial electrography into commercial programers . 1. Using computerized heart simulator , delays of the telemetric electrogram and markers were investigated in 12 DDD systems of 9 different companies . 2. To measure interatrial conduction times with programers , simultaneous recordings of right atrial electrogram and marker channel , resp. , and the left atrial electrogram were performed using external hardware or internal software filtering of the esophageal lead . Depending on the range of marker delay , pacing systems with real-time telemetry ( delay 0-12ms) and orienting telemetry ( delay \\gg12ms) were found . Facilitating left atrial electrogram recording into programers , interatrial time intervals can be measured in DDD and VDD operation in pacing systems with real-time telemetry . These results are prerequisits for individual AV delay programming with the programer . Then both can automatically be proposed , basic AV delay and the frequency modulated AV delay . Facilitating left atrial electrogram recording into pacemaker programers , interatrial conduction times can easily be measured for simplified physiologic AV delay programming during routine check-up ."
],
"offsets": [
[
0,
1931
]
]
}
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Herzschrittmachertherapie.80090270.eng.abstr
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"An essential feature of the known procedures for the analysis of the ECG signal is the splitting of the ECG into individual parameters which are subsequently processed in defined decision trees , neuronal networks or statistical procedures to diagnostic information . The correctness of the diagnostic statements thus substantially depends on the suitable selection and the exact determination of the individual criteria . The analysis algorithm and the expert knowledge are closely linked due to the procedure . This paper presents a new procedure or the evaluation of signals of medical sensor systems by the example of the ECG . Unlike the methods used up to now , this procedure is not based on an ever more profound splitting of the ECG signal into individual features . Furthermore , analysis algorithm and knowledge base are separated from each other . The consideration underlying the procedure is that two ECGs whose leads show identical or very similar signal patterns indicate identical or at least very similar cardiological diagnoses . As this assumption is the basis of medical experience , it should be possible to compare the signal patterns of the leads of an unknown ECG with those of the leads of the reference ECGs from a database and to draw conclusions for the diagnosis of the unknown ECG . For this purpose , those ECGs are searched in an ECG database whose leads show greatest agreement with the signal pattern of the unknown ECG . The function of the method was established with the aid of the ECG signal database CARDIODAT with 249 ECGs for the diagnostic groups : infarcts and healthy reference persons from a data inventory of 550 ECGs . It can be seen from the results that the presented procedure which is based on signal pattern recognition is a new approach to deriving diagnostic information from the ECG signal at least for the diagnostic group of myocardial infarcts ."
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Herzschrittmachertherapie.8009s001.eng.abstr
|
Herzschrittmachertherapie.8009s001.eng.abstr
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{
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"text": [
"There has been almost no change in the basic guidelines on cardiopulmonary resuscitation during the last 30 years . The introduction of early defibrillation programs and further propagation of resuscitation skills in the entire population are steps for improvement which have not yet been fully realized . On the other hand , some basic rules for resuscitation have to be reconsidered with skepticism . The guidelines for pulse control are apparently insufficient for correct diagnosis , and the value of mouth-to-mouth ventilation in nontraumatic sudden cardiac death in adults must be re-evaluated . However , there are some promising new aspects for the use of the active compression-decompression resuscitation and other newly developed mechanical resuscitation techniques . With respect to electrotherapy external defibrillation utilizing a biphasic shock may lead to higher efficiency , higher survival rates , and less myocardial damage . As far as adjuvant medication is concerned , vasopressin was reported to be superior to suprarenin in a small randomized study and may soon become the substance of choice in special situations such as refractory ventricular fibrillation . This also holds true for amiodarone which may play a major role in antiarrhythmic therapy in refractory ventricular fibrillation/tachycardia ."
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Herzschrittmachertherapie.8009s009.eng.abstr
|
Herzschrittmachertherapie.8009s009.eng.abstr
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"The implantable cardioverter defibrillator ( ICD ) has been approved by the Food and Drug Administration since 1985 and is widely used in practice . Until very recently , however , the efficacy of the ICD has depended on large published series of retrospective studies analyzing ventricular tachycardia and fibrillation patients . The recently published antiarrhythmics versus implantable defibrillator ( AVID ) trial is the first prospective randomized trial to show clearly that the ICD is more effective than drug therapy ( amiodarone or sotalol ) in patients who have survived an out-of-hospital cardiac arrest or have syncopal or hemodynamically significant ventricular tachycardia . The survival advantages probably holds true only for patients with an ejection fraction under 35% who have either coronary disease or other forms of cardiomyopathy . The survival advantage in this trial - which was halted prematurely because of the results noted - was short-lived ( 2.6 months ) and expensive . The results of this trial will clearly define the role of the ICD in everyday clinical practice and will be of invaluable benefit to patients , physicians , and insurers alike ."
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[] |
[] |
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Herzschrittmachertherapie.8009s020.eng.abstr
|
Herzschrittmachertherapie.8009s020.eng.abstr
|
[
{
"id": "Herzschrittmachertherapie.8009s020.eng.abstr-passage-0",
"type": "abstract",
"text": [
"The electrophysiologic mechanisms for the maintenance of atrial fibrillation still needs to be elucidated . The multiple wavelet hypothesis of Moe could be confirmed in experimental and clinical mapping studies . However , the role of preferential pathways , periodicities , and other factors for the perpetuation of atrial fibrillation is unclear . In intraoperative biatrial mapping studies , Cox et al. could demonstrate complete reentrant circuits during atrial fibrillation in the right atrium . Left atrial reentry could not be demonstrated , probably due to the limited spatial mapping resolution in that area . In other intraoperative mapping studies , Konings et al. registered the activation sequences during atrial fibrillation at the right atrial free wall with very high spatial resolution . Based on the spatiotemporal complexity of atrial activation during atrial fibrillation , three types of atrial fibrillation were defined . Patients were classified according to the predominant activation pattern and , therefore , the classification in different types is part of a continuous spectrum . Haissaguerre et al. performed catheter mapping studies to investigate regional disparities in fibrillatory activity during paroxysmal atrial fibrillation . In their study , edocardially trabeculated areas revealed predominantly organized activity during atrial fibrillation , whereas the nontrabeculated areas were significantly more fibrillatory . In most cases , atrial fibrillation resulted from the simultaneous existence of instable reentrant circuits . However , in a small subgroup of young patients without structural heart disease , the typical surface ECG pattern of atrial fibrillation was produced by a single focal source that could successfully be ablated with discrete radiofrequency energy application ."
],
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[] |
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Herzschrittmachertherapie.8009s025.eng.abstr
|
Herzschrittmachertherapie.8009s025.eng.abstr
|
[
{
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"Methods to predict the rate of spontaneous relapses in paroxysmal atrial fibrillation and the effectiveness of antiarrhythmic agents are missing . P-wave signal averaging might be helpful in this setting . However , correct validation and standardization is strongly needed for p-wave analysis with the high resolution ECG . Signal averaging triggered to the p-wave is significantly superior to QRS-triggering . Bidirectional filtering or FIR-filtering is necessary . The data indicate significant differences in p-wave duration between patients with and without paroxysmal artrial fibrillation . Class I antiarrhythmic agents demonstrate a significant prolongation of p-wave duration , but did not influence spectral parameters . Treatment with sotalol reduces high frequency p-wave energy without altering p-wave duration . After optimizing the methods , p-wave analysis offers promise to separate patients prone to atrial fibrillation and normals . In addition , the evaluation of antiarrhythmic efficacy in patients with high risk of recurrent atrial fibrillation might be possible ."
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Herzschrittmachertherapie.8009s031.eng.abstr
|
Herzschrittmachertherapie.8009s031.eng.abstr
|
[
{
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"Atrial fibrillation is the most common arrhythmia in humans , with a prevalence of 2% to 4% after the age of 60. Anticoagulation therapy has proven effective to reduce morbidity and mortality associated with this arrhythmia . Symptoms vary widely among patients and respond unpredictably to antiarrhythmic drug therapy . Strategies alternative to drug treatment include radiofrequency catheter ablation , implantable atrial defibrillator , and surgical \" maze \" atrial compartmentalization . The implantable atrial defibrillator is presently being investigated as a potential tool , although its clinical applicability remains questionable . Surgical compartmentalization has proven effective to cure atrial fibrillation of the permanent and the paroxysmal type ; however , due to its invasivness , this procedure is indicated in very selected cases and performed in few centers . The objective catheter ablation for the therapy of atrial fibrillation is twofold : 1 ) the reduction and regularization of heart rate ; and 2 ) the primary treatment of the electroanatomical substrate generating and sustaining atrial fibrillation . The former objective is achieved through radiofrequency-induced \" modification \" or permanent interruption ( together with pacemaker implantation ) of the atrioventricular conduction . Clincial improvement in about 80% of cases has been reported with both methods . The primary treatment of atrial fibrillation has been recently proposed based on a replication of the surgical compartmentalization model using catheter techniques . Preliminary results show that the technique is feasible , although its effectiveness must be improved . Possible applications of this technique are facilitated by the recent introduction of a nonfluoroscopic computer-assisted mapping techniques allowing three-dimensional electroanatomical reconstruction of the target chamber ."
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] |
Herzschrittmachertherapie.8009s036.eng.abstr
|
Herzschrittmachertherapie.8009s036.eng.abstr
|
[
{
"id": "Herzschrittmachertherapie.8009s036.eng.abstr-passage-0",
"type": "abstract",
"text": [
"Given the high prevalence of atrial fibrillation and the lack of effective therapeutic options , the recent suggestion of biatrial or dual site right atrial pacing as a means of preventing atrial tachyarrhythmia has gained major interest . Data presented so far come from interventions in very specific patient groups ( for example , from patients with atypical flutter ) or from comparisons between the pre- and postimplant course of patients paced for the brady-tachy syndrome by a conventional and dual site atrial approach . Although success rates of 77 up to 91% under an optimum antiarrhythmic drug regimen are promising , there is a lack of sufficiently large randomized trials and a need for insights in the basic mechanisms which make this approach likely to be effective . Based on observations on the spontaneous onset of atrial fibrillation , overdrive pacing and the preexcitation of the ( presumably ) arrhythmogenic substrate may be valid concepts of arrhythmia prevention ."
],
"offsets": [
[
0,
989
]
]
}
] |
[
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25
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},
{
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[] |
[] |
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] |
Herzschrittmachertherapie.8009s044.eng.abstr
|
Herzschrittmachertherapie.8009s044.eng.abstr
|
[
{
"id": "Herzschrittmachertherapie.8009s044.eng.abstr-passage-0",
"type": "abstract",
"text": [
"Currently , no therapy exists which reliably avoids recurrences of episodes of sustained atrial fibrillation and prevents the development of permanent , chronic atrial fibrillation . As antiarrhythmic drugs have rare but partly substantial side-effects , many patients are left with their atrial fibrillation and their ventricular rate can only be controlled by drugs or catheter ablation of the atrioventricular node . Due to the success of implantable cardioverter-defibrillators for ventricular tachyarrhythmias and the very effective treatment of atrial fibrillation by internal atrial defibrillation , implantable devices have been designed which can automatically defibrillate atrial fibrillation . Preliminary experience has been obtained with these devices in a few selected patients . Patients could be maintained in sinus rhythm during short-term follow-up and no ventricular proarrhythmic effects due to shock delivery were documented . However , the patients ' tolerance of shocks and the amount of shocks needed to terminate episodes of atrial fibrillation is a major concern . Before indications for general use of implantable atrial defibrillators can be defined , further experience with such devices within studies is needed ."
],
"offsets": [
[
0,
1243
]
]
}
] |
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] |
[] |
[] |
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Herzschrittmachertherapie.8009s052.eng.abstr
|
Herzschrittmachertherapie.8009s052.eng.abstr
|
[
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"Most sudden cardiac deaths are arrhythmic . Besides the known effects of beta-blockers , among true antiarrhythmic drugs only amiodarone seemed to reduce total cardiac mortality in patients at risk . Reevaluation of amiodarone with or without a beta-blocker in primary prophylaxis of sudden cardiac death after review of recent publications . Only augmentation of case numbers by meta-analyses of controlled trials could demonstrate that amiodarone not only reduces sudden cardiac death but also diminishes total cardiac mortality . However , the number of avoided sudden deaths is small in comparison to the number of treated cases . This and specific side effects of amiodarone contradict a general primary prophylaxis with this drug . An additional benefit by combining amiodarone with beta-blockers seems to exist but has to be proven by further studies . At present , primary prophylaxis of sudden cardiac death with amiodarone with or without a beta-blocker is an individual decision in all cases with special risk considerations ."
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Herzschrittmachertherapie.8009s061.eng.abstr
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Herzschrittmachertherapie.8009s061.eng.abstr
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] |
Herzschrittmachertherapie.8009s073.eng.abstr
|
Herzschrittmachertherapie.8009s073.eng.abstr
|
[
{
"id": "Herzschrittmachertherapie.8009s073.eng.abstr-passage-0",
"type": "abstract",
"text": [
"The pharmacological and/or electrical conversion of atrial fibrillation implicates considerable complications which in some cases can even cause the death of a patient . Proarrhythmias , embolizations , hemorrhages , bradycardia , and left ventricular failure partially with following death have been reported . The complication rate of pharmacological conversion is highest in the first 1-3 days ; the complication rate of electrical conversion in the first 24 hours . Therefore , both forms of conversion have to be performed with continuous monitoring and the back up of an intensive care unit . That implicates that a clinical setting is necessary for any kind of conversion ."
],
"offsets": [
[
0,
680
]
]
}
] |
[
{
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109
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149,
154
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"patient"
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160,
167
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{
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],
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200
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{
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],
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203,
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},
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316,
328
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{
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{
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{
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596
]
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"normalized": [
{
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"db_id": "C0021708"
}
]
}
] |
[] |
[] |
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Herzschrittmachertherapie.8009s079.eng.abstr
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Herzschrittmachertherapie.8009s079.eng.abstr
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Herzschrittmachertherapie.90100003.eng.abstr
|
Herzschrittmachertherapie.90100003.eng.abstr
|
[
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[
0,
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[] |
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Herzschrittmachertherapie.90100007.eng.abstr
|
Herzschrittmachertherapie.90100007.eng.abstr
|
[
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"Enthusiasm for permanent pacing as a therapeutic option for patients with dilated cardiomyopathy ( DCM ) and congestive heart failure ( CHF ) has waxed and waned since the early 1990 ' s. The clinical results of standard dual-chamber pacing in these patients have been extraordinarily mixed , which can be attributed to small patient populations , marked heterogeneity of patients included , highly variable study designs and endpoints , and limited follow-up . Although investigators have postulated some mechanisms for improvement , there is still a great deal to learn to be able to reliably predict which patients with DCM and/or CHF will respond to permanent pacing . Biventricular pacing is emerging as having the greatest potential for patients with congestive cardiomyopathy . Although data is somewhat limited , triple-chamber , and in some cases four-chamber pacing will be the focus of future interest ."
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0,
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[] |
[] |
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] |
Herzschrittmachertherapie.90100016.eng.abstr
|
Herzschrittmachertherapie.90100016.eng.abstr
|
[
{
"id": "Herzschrittmachertherapie.90100016.eng.abstr-passage-0",
"type": "abstract",
"text": [
"Decreases in cardiac function accompanying heart failure are at least partially due to aberrations in electrical activation that result in reduced coordination among chambers and myocytes within any single chamber . This discoordinate activity decreases overall efficiency resulting in reduced output or , if output is maintained , increased myocardial oxygen consumption . Pacing has been shown to improve function by either 1 ) improving coordination between atrium and ventricle , thus increasing transport of blood into the ventricle and maximizing preload , as well as 2 ) reducing mitral or tricuspid regurgitation or by 3 ) improving coordination between ventricles to minimize paradoxical septal motion or , finally , by 4 ) improving mechanical coordination of myocytes within a ventricle . Incoordinate myocyte activation in the left ventricle is observed as depressed global contractile function , since only a fraction of myocytes contract simultaneously and as decreased myocardial compliance since myocytes do not relax simultaneously . Recoordinating myocytes by cardiac pacing can dramatically alter global measures of contractility and diastolic function within just a few paced beats presumably without increasing oxygen consumption ."
],
"offsets": [
[
0,
1252
]
]
}
] |
[
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29
]
],
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],
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48
]
],
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{
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],
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159
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[] |
[] |
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Herzschrittmachertherapie.90100023.eng.abstr
|
Herzschrittmachertherapie.90100023.eng.abstr
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[
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"Congestive heart failure is a very common syndrome with an annual incidence of 400000 cases per year . It is also associated with a high mortality that approaches 50% at five years , with roughly one-third of these deaths being caused by cardiac arrhythmias . A variety of approaches have been taken in the treatment of congestive failure . Randomized trials have shown that the use of ACE inhibitors improves survival in congestive failure , with some trials also showing a reduction in sudden cardiac death . Other randomized trials have studied the role of amiodarone in the treatment of congestive failure . These trials , in general , have shown that total mortality is not effected by amiodarone but the sudden death risk is reduced . The role of beta blockers has recently gained attention in the Carvedolol trial which showed significant improvement with the use of a nonselective beta blocker . Finally , a variety of studies involving the use of the implantable cardioverter defibrillator are underway which will determine if the ICD can reduce the arrhythmic risk posed by the presence of congestive failure . Most experts think that the combined use of ACE inhibitors , beta blockers and likely the ICD as well will see a significant reduction in the mortality rate of patients with established congestive failure ."
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Herzschrittmachertherapie.90100030.eng.abstr
|
Herzschrittmachertherapie.90100030.eng.abstr
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[
{
"id": "Herzschrittmachertherapie.90100030.eng.abstr-passage-0",
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"Experimental animal models of ventricular arrhythmias have been developed to investigate the mechanisms of arrhythmogenesis in man . Ventricular arrhythmias associated with ischaemia and infarction often cannot be elucidated by clinical studies on patients because those arrhythmias are potentially lifethreatening and their occurrence is unpredictable . Because of additional experimental procedures and techniques that can be used in the animal laboratory , such as microelectrode recording of transmembrane action potentials and high-density optical and electrical activation mapping , animal models have provided information that cannot be obtained from clinical studies . Studies on animal models have provided new ideas and hypotheses that have been tested in clinical studies and that have been found to be true for clinical arrhythmias . Animal models have enabled the mechanisms of fibrillation and defibrillation to be understood and new therapeutic concepts to be developed . The purpose of this article is to briefly review some animal models of ventricular tachycardia and fibrillation . Some contributions that these animal studies have made to our understanding of ventricular tachyarrhythmias will be discussed . Because of the clinical importance of coronary artery disease this article concentrates on those arrhythmias caused by myocardial ischaemia and infarction ."
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] |
Herzschrittmachertherapie.90100046.eng.abstr
|
Herzschrittmachertherapie.90100046.eng.abstr
|
[
{
"id": "Herzschrittmachertherapie.90100046.eng.abstr-passage-0",
"type": "abstract",
"text": [
"An aim in present-day pacemaker therapy is to achieve a high pacing impedance , because this additionally reduces the pacing current of a pacemaker at similar pacing impulses . The purpose of the study was to assess whether the right ventricular apex ( RVA ) is the position with the highest pacing impedance . The study included 31 patients undergoing an electrophysiological study . The same catheter was placed in the RVA , at the tricuspid valve ( TV ) , and in the right ventricular outflow tract ( RVOT ) . Pacing impedance was measured at 5.0V pulse amplitude and 0.5ms pulse duration ; additionally , the pacing threshold at 0.5ms pulse duration and R-wave amplitude was determined . Mean impedance was 591+/-111 in the RVA , 578+/-157 at the TV , and 576+/-95 in the RVOT . Pacing threshold was 0.8+/-0.3V in all 3 positions and R-wave amplitude was 14.1+/-5.7mV ( RVA ) , 12.4+/-5.0mV ( TV ) , and 12.5+/-5.8V ( RVOT ) , respectively . The highest impedance was measured in the RVA in 14 , at the TV in 6 and in the RVOT in 11 patients . In 17 patients with a higher impedance outside the RVA repositioning of the catheter increased impedance by 147+/-139 ( range : 11-539 ) . In these 17 patients , repositioning of the catheter neither changed the pacing threshold ( 0.07+/-0.3V) nor the R-wave amplitude ( 1.0+/-5.6mV). The different catheter positions in the right ventricle did not influence pacing threshold , impedance or R-wave amplitude . Fifty-five percent of the patients had the highest impedance when the catheter was placed outside the RVA which increased impedance by 147+/-139 . The repositioning was not associated with pacing threshold or R-wave amplitude changes . The findings indicate that the intraoperative impedance can be modified by the lead position ."
],
"offsets": [
[
0,
1788
]
]
}
] |
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] |
[] |
[] |
[
{
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] |
Herzschrittmachertherapie.90100051.eng.abstr
|
Herzschrittmachertherapie.90100051.eng.abstr
|
[
{
"id": "Herzschrittmachertherapie.90100051.eng.abstr-passage-0",
"type": "abstract",
"text": [
"Electrical atrial remodeling during rapid atrial activation is known to be an important phenomenon for perpetuation of atrial fibrillation . Recent studies have demonstrated that electrical remodeling is mediated by an increase in calium currents through L-type calcium channels during atrial fibrillation . Electromechanical factors may also contribute to the observed shortening in the effective refractory period ( ERP ) during atrial remodeling . The purpose of our study was to examine the influence of right atrial pressure on electrical remodeling during high frequency pacing in an intact animal model . 10 closed-chest dogs ( 25+/-1kg) were studied during continuous autonomic blockade with i.v. Atropine ( bolus : 0.04mg/kg followed by 0.007mg/kg/h) and i.v. Propranolol ( bolus : 0.2mg/kg followed by 0.04mg/kg/h). The right atrial appendage was paced for 7 hours at a rate of 800bpm ( 4mA ) . Right atrial pressure and systemic blood pressure were continuously recorded . Atrial ERP was determined at a different right atrial site every hour at a basic cycle length of 350ms . After 7h pacing , animals were divided into two groups according to the mean right atrial pressure ( group 1 : 4+/-0 . 2mmHg versus group 2 : 7+/-1mmHg; p 0.01 ) . Despite autonomic blockade , significant electrical remodeling was observed in all animals . The decrement in ERP was significantly greater in group 2compared to group1 ( group1 : 166+/-12ms to 145+/-16ms versus group2 : 164+/-14ms to 126+/-17ms; p 0.05 ) . The duration of induced atrial fibrillation was significantly longer in group 2 compared to group1 ( 59+/-22s vs. 19+/-12s; p 0.05 ) . The mean AF cycle length was not significantly different in both groups ( 135+/-27ms vs. 142+/-24ms; p=ns). While ERP reached baseline 30 minutes after cessation of rapid pacing in group 1 the ERP remained shorter in group2 ( 91+/-8% ; p=0.054). There were no differences in blood pressure , mean atrial or ventricular rates between the two groups . Atrial remodeling is accentuated by elevated right atrial pressure despite complete autonomic blockade . Thus , increases mechanical stretch produced by elevated atrial pressure may be an additional factor which contributes to electrical remodeling during atrial fibrillation ."
],
"offsets": [
[
0,
2273
]
]
}
] |
[
{
"id": "Herzschrittmachertherapie.90100051.eng.abstr-s1-t1",
"type": "umlsterm",
"text": [
"atrial fibrillation"
],
"offsets": [
[
119,
138
]
],
"normalized": [
{
"db_name": "UMLS",
"db_id": "C0004238"
}
]
},
{
"id": "Herzschrittmachertherapie.90100051.eng.abstr-s2-t1",
"type": "umlsterm",
"text": [
"calcium"
],
"offsets": [
[
262,
269
]
],
"normalized": [
{
"db_name": "UMLS",
"db_id": "C0006675"
}
]
},
{
"id": "Herzschrittmachertherapie.90100051.eng.abstr-s2-t2",
"type": "umlsterm",
"text": [
"calcium channels"
],
"offsets": [
[
262,
278
]
],
"normalized": [
{
"db_name": "UMLS",
"db_id": "C0006685"
}
]
},
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] |
[] |
[] |
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Herzschrittmachertherapie.90100164.eng.abstr
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Herzschrittmachertherapie.90100164.eng.abstr
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[
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"Though the problem of interference of pacemakers under high voltage power lines has been described already 1983 , it can not be regarded as solved . The question , therefore , should be answered how large are the fields beneath power lines and which sensing thresholds are to be programmed to overcome the problem . While the electric field under power lines are constant with respect to time but depend on distance , height , and voltage , the magnetic field varies depending on load . With the maximum electric field of 5.24kV/m and magnetic field of 14.3µT, it can be calculated that the electrically influenced voltage amounts to 2.2mV , whereas the magnetically induced voltage remains below 0.3mV . Both voltages must be added for the most unfavorable case . Investigating 134 DDD pacemakers removed from deceased patients revealed that the most sensitive one reacted already at 0.85mV 50Hz signals , 23% of all would be influenced at 2mV . The most sensitive pacemaker would , according to our calculations , be interfered with an electric field of 2kV/m. Magnetic fields under powerlines can not influence pacemakers . To remove all dangers from pacemaker patients under high voltage power lines , unipolar systems should have a ventricular sensing threshold of at least 5mV ."
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[] |
[] |
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Herzschrittmachertherapie.90100170.eng.abstr
|
Herzschrittmachertherapie.90100170.eng.abstr
|
[
{
"id": "Herzschrittmachertherapie.90100170.eng.abstr-passage-0",
"type": "abstract",
"text": [
"Aim of the study and methods : In the present study the correlation between ischemia induced ventricular tachyarrhythmias and a dynamic behavior of ventricular late potentials was investigated . In 16 patients with significant coronary artery disease and survived sustained ventricular tachyarrhythmia an electrophysiologic study ( EPS ) was performed . Before EPS ( t1), at every stimulation interval and after induction of a ventricular tachycardia or ventricular fibrillation ( VT/VF ) the lactate concentration was measured in arterial blood and in the coronary sinus for calculation of the myocardial lactate extraction . Furthermore , before investigation , after induction of a VT/VF and after a 10 minute recovery phase an analysis of the signal averaged ECG was performed . Nine patients showed a so-called \" lactate reversal \" , i.e. , an increase of the lactate concentration in the coronary sinus over the concentration of the arterial blood as an expression of ischemia development , during inducibility of a VT/VF ( group A ) . The control group consisted of 7 patients without ischemia related VT/VF ( group B ) . Results : In group A significant changes of the three late potential criteria were found between t1 and t2 ( QRS : 115.61 +/- 13.86 vs. 126.06 +/- 16.74 , p=0.08; RMS : 25.81 +/- 22.26 vs. 13.11 +/- 10.72 , p=0.01; LAS : 37.72 +/- 19.26 vs. 50.06 +/- 10.72 , p=0.01). In group B , no significant changes could be measured . Furthermore , the prevalence of late potentials increased in group A from 66% ( t1) to 89% ( t2), whereas in group B no increase was detectable . Conclusions : These data suggest a dynamic behavior of ventricular late potentials in correlation with the inducibility of ventricular tycharrhythmias due to ischemic circumstances . Therefore the dynamic behavior of ventricular late potentials can be an expression of a modification of the arrhythmogenic substrate in arrhythmia endangered patients ."
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Herzschrittmachertherapie.90100178.eng.abstr
|
Herzschrittmachertherapie.90100178.eng.abstr
|
[
{
"id": "Herzschrittmachertherapie.90100178.eng.abstr-passage-0",
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"Objectives : To clarify the incidence of sudden arrythmic death and associated risk factors in patients after orthotopic heart transplantation ( HTx ) . Background : Some reports indicate a significant rate of sudden death in heart transplant recipients limiting long-term success of the operation . Incidence , underlying risk factors , etiologies , and methods for prediction or prevention of sudden death are poorly defined . Methods : Retrospective analysis of our cohort of 120 cardiac allograft recipients surviving the perioperative phase out of a total of 142HTx patients of the years 1984-1999 . Clinical events ( death , mode of death , Re-HTx , resuscitation ) were noted and analyzed by the Kaplan-Meier method and related to the patients ' characteristics by multivariate analysis . Sudden death in or out of hospital was defined as death within one hour of symptoms or unwittnessed death . Clinical and postmortem findings ( autopsies are available in 12/18 sudden death patients ) were correlated to the mode of death . Results : During a mean follow-up interval of 4.6 +/- 3.5 years , 45 patients died ( 38% ) . The mode of death was non-sudden in 27 inpatients . 18 deaths were sudden , 14 of these out of hospital . In addition there were three cardiac arrests with successful resuscitations , one of those patients died three month later suddenly , giving a number of a total of 21 cardiac arrests in 20HTx patients . The actuarial risk of cardiac arrest was 20% after 6 and 40% after 12 years . Based on postmortem analysis the etiologies of the events were attributed to transplant vasculopathy in 15 patients , rejection in 5 patients ( International Society for Heart and Lung Transplantation grade > 3A ) , and to unknown reasons in one . All three patients successfully resuscitated from cardiac arrest had documented bradycardic events ( 2xtotal AV block , 1xsinus arrest ) . Pacemakers were implanted in these patients . One of those died suddenly 2 months later . Significantly more HTx patients dying suddenly are smokers , had a lower left ventricular ejection fraction , and worse hemodynamics . QRS width and PR interval were significantly broadened in patients with transplant vasculopathy and cardiac arrest . In three cases , a decrease in heart rate variability , the occurence of sustained VT , and ST segment depressions prior to the cardiac arrest could be demonstrated . Conclusions : Sudden death occurs at a substantial rate after HTx . As HTx patient numbers are rising constantly , sudden cardiac death in this population will represent a significant problem . In our patients about 75% of the arrests can be attributed to graft-vasculopathy and one quarter to acute rejection . Diagnostic strategies have to be developed to detect patients at risk . Interestingly , some events may be caused from bradyarrhythmic rhythm disturbances ."
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Herzschrittmachertherapie.90100185.eng.abstr
|
Herzschrittmachertherapie.90100185.eng.abstr
|
[
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"There are different causes for the variable extent of preexcitation in patients with the WPW syndrome . The appearance of an ectopic atrial rhythm is rarely the reason for a temporary complete loss of delta waves in the ECG . This setting does not lead to identification of patients at risk with preexcited atrial fibrillation . However , in some patients with symptomatic arrhythmias the estimation of antegrade conduction properties of the accessory pathway does not require the performance of an electrophysiologic study . In the present case of a patient with intermittent preexcited atrial fibrillation , pharmacological therapy in contrast to radiofrequency catheter ablation of the accessory pathway seems to be suitable , because of slow conduction over the bypass tract and infrequent episodes of arrhythmias ."
],
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[] |
[] |
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Herzschrittmachertherapie.90100208.eng.abstr
|
Herzschrittmachertherapie.90100208.eng.abstr
|
[
{
"id": "Herzschrittmachertherapie.90100208.eng.abstr-passage-0",
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"text": [
"Complete atrioventricular block ( AVB ) is a rare dysrhythmia in childhood , the etiology of which can be attributed to a number of causes . The aim of this study was to monitor the different causes , the clinical courses , and the indications for pacemaker therapy . Methods : In a retrospective analysis case histories , ECGs and Holter-ECGs from 71 patients with permanent AVB were reviewed . In addition , in selected cases cardiac catheterization and exercise testing were performed . Results : 37% had a congenital , and 48% an acquired AVB ; in 15% of the cases the age of onset could not be determined . Among the neonates 31% each could be attributed to a congenital heart defect ( CHD ) or a maternal collagenosis ; in 38% the reason could not be determined . The acquired AVB was most commonly the result of cardiac surgery . Other reasons were CHD without surgery ( 18% ) , myocarditis ( 15% ) , heart catheterization ( 6% ) or cardiomyopathy ( 3% ) . 48% of patients required the implantation of a pacemaker ( PM ) . The frequency of this operation depended on the cause of the AVB . It was , for instance , 100% in patients after cardiac surgery and 46% in patients with congenital AVB . Six patients had a long QTc interval , not one a malignant ventricular dysrhythmia . However , in the Holter-ECGs and during exercise testing , approximately 30% of the patients had ventricular extra beats . On the whole , the mortality was 19% ; notably , these were all patients with CHD . Conclusion : The majority of pediatric AVB is either congenital or a complication of cardiac surgery . The necessity of PM implantation depends on the etiology of the AVB . Relevant ventricular dysrhythmias are rare in childhood ; however , the physical capacity of the patients in the absence of CHD remains slightly reduced . The mid-term prognosis of patients with AVB without structural heart disease is good ."
],
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Herzschrittmachertherapie.90100222.eng.abstr
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Herzschrittmachertherapie.90100222.eng.abstr
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[
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"VDD pacing using a single pass lead for complete heart block is well described in adults but there are few reports of its use in children . We have used 6 different standard adult size single pass leads and 5 different pacemaker generators in 21 children and adolescents aged 3.7-17.2 years ( mean 9.9 years ) and weighing 13.5 to 76 kg ( mean 34.3 kg ) . Congenital complete heart block was present in 14 patients ( with associated heart disease in 2 of them ) , surgical complete heart block in 6 patients and 2:1 AV block of uncertain cause in 1 patient . In 10 patients , the VDD system was their first pacing system . In 11 of the patients , 1-6 previous systems had been used and simultaneous extraction of ventricular leads ( 10 ) and/or atrial leads ( 5 ) was performed . All leads were introduced via a subclavian vein puncture ( using the extraction sheath when present ) and the atrial dipole was placed low in the right atrium to provide slack for further growth while maintaining atrial sensing . Ventricular thresholds ranged from 0.2 to 0.8 V. The minimal atrial amplitude was 0.7 to 4 mV and the maximum amplitude was 2.5 to 8 mV . There was one early micro-displacement and the lead was repositioned . Over a follow-up period of 2-64 months ( mean 32 months ) , all but 1 of the patients have maintained low ventricular pacing thresholds and adequate atrial signals for reliable pacing at rest and with exercise . During this time some have undergone considerable growth . In 1 patient , atrial sensing was lost after cardiopulmonary bypass for additional cardiac surgery at 24 months and the pacemaker was programmed into VVIR mode . One patient with coexisting congenital heart disease died suddenly at 3 years but the pacing system had no fault at autopsy . The standard adult size single pass lead provides a simple means to enable reliable atrial synchronous ventricular pacing in growing children with complete heart block ."
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] |
Herzschrittmachertherapie.9010s015.eng.abstr
|
Herzschrittmachertherapie.9010s015.eng.abstr
|
[
{
"id": "Herzschrittmachertherapie.9010s015.eng.abstr-passage-0",
"type": "abstract",
"text": [
"Background : The incidence of atrial arrhythmia ( AA ) in a DDD paced population is high . Mode switch ( MS ) functions are today widely used to manage AA during dual chamber sequential pacing . Aim and method : This work aims to present the new MS function of the Chorum ( ELA Medical ) . It is based on the diagnosis of the acceleration of the atrial rhythm to detect premature atrial contractions and on the statistical analysis of the atrial rhythm to diagnose sustained AA . It is fully automatic and independent from programmed parameters including upper rate limit . Results : A clinical evaluation with Holter recordings in 194 patients revealed a high sensitivity ; due to the statistical approach of the atrial rhythm AA was appropriately detected even in the case of partial loss of atrial sensing . Additionally , a high specificity could be demonstrated due to the ability of the algorithm to discriminate between pathological atrial rate and normal sinus tachycardia on the basis of the rate acceleration . Still false-positive response of MS occurred , for example , due to oversensing of ventricular far-field signals which can be corrected by reprogramming the device . Specific memory functions allow the clinician to follow up the patient using stored MS episodes . Especially marker chains recorded during MS help to identify false-positive response of MS and to suggest reprogramming of the device . Conclusion : Thus , MS and associated memory function are complementary tools to optimize the functioning of the device and the patient's follow-up ."
],
"offsets": [
[
0,
1570
]
]
}
] |
[
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"incidence"
],
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[
17,
26
]
],
"normalized": [
{
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"db_id": "C0220856"
},
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"db_id": "C0021149"
}
]
},
{
"id": "Herzschrittmachertherapie.9010s015.eng.abstr-s1-t2",
"type": "umlsterm",
"text": [
"arrhythmia"
],
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[
37,
47
]
],
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{
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}
]
},
{
"id": "Herzschrittmachertherapie.9010s015.eng.abstr-s1-t3",
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"DDD"
],
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63
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],
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80
]
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"id": "Herzschrittmachertherapie.9010s015.eng.abstr-s2-t1",
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"functions"
],
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110,
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]
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Herzschrittmachertherapie.9010s022.eng.abstr
|
Herzschrittmachertherapie.9010s022.eng.abstr
|
[
{
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"Background : Mode switching aims to maintain a ventricular rhythm that matches metabolic needs during both sinus rhythm and atrial tachyarrhythmias . This allows patients with atrial arrhythmias to benefit from AV synchronous pacing modes . Aim and method : Beat-to-beat mode switching in Diamond and Clarity pacemakers is designed to maintain a relatively stable ventricular rhythm , ensuring consistent ventricular filling patterns . Atrial tachyarrhythmia detection is based on a continuous analysis of the atrial rhythm . A too rapid increase of the atrial rate with a beat-to-beat acceleration > 15 bpm is considered to be an atrial tachyarrhythmia . Mode switching occurs on detection of the first premature atrial event : atrial tracking is stopped and the ventricular rate is determined by the rate indicated by the dual sensor ( QT interval and activity ) . Atrial pacing restores AV synchrony immediately after cessation of the atrial tachyarrhythmia , effectively avoiding retrograde conduction . Dedicated diagnostic functions allow one to monitor the incidence of atrial tachyarrhythmias and to study atrial and ventricular events just prior to its onset . Both the mode switching and rate responsive function are fully automatic , rendering follow-up procedures easy and less time-consuming . Conclusion : Reliable detection of all atrial events is essential to guarantee appropriate mode switching . Therefore , the pacemaker stores the distribution of the amplitude of all atrial events , both during sinus rhythm and atrial tachyarrhythmias , which facilitates the appropriate programming of the atrial sensitivity ."
],
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0,
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[] |
[] |
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Herzschrittmachertherapie.9010s023.eng.abstr
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Herzschrittmachertherapie.9010s023.eng.abstr
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Herzschrittmachertherapie.9010s032.eng.abstr
|
Herzschrittmachertherapie.9010s032.eng.abstr
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[] |
[] |
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Herzschrittmachertherapie.9010s034.eng.abstr
|
Herzschrittmachertherapie.9010s034.eng.abstr
|
[
{
"id": "Herzschrittmachertherapie.9010s034.eng.abstr-passage-0",
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"Atrial fibrillation and related arrhythmias are common after cardiac surgery . As more and more elderly patients are operated on for cardiac diseases , the interest in this arrhythmia is growing again . There are some unresolved problems of this complication . Reevaluation of atrial fibrillation after cardiac surgery by review of recent literature . Usually postsurgical atrial fibrillation is transient , self-limiting , and benign . Nevertheless , among patients affected by this arrhythmia , morbidity , mortality and costs by hospital stay are higher than without this complication . In addition , postsurgical atrial fibrillation can increase morbidity and mortality by itself . Pathogenesis is multifactorial . Today , general recommendations for prevention of atrial fibrillation following surgery do not exist but may be developed in the future . According to the clinical course , therapy has to consider ventricular rate control , prevention of thromboembolic events , and rhythm control . Usually therapy is restricted to the postoperative time . Atrial fibrillation after cardiothoracic surgery has to be respected in order to minimize overall complication rate ."
],
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[] |
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Herzschrittmachertherapie.9010s039.eng.abstr
|
Herzschrittmachertherapie.9010s039.eng.abstr
|
[
{
"id": "Herzschrittmachertherapie.9010s039.eng.abstr-passage-0",
"type": "abstract",
"text": [
"Atrial fibrillation is the most commonly encountered sustained arrhythmia in men . It is associated with a two-fold mortality risk and an increased cost for health care providers . The relative inefficacy and the risks of pharmacologic approaches to atrial fibrillation therapy have contributed to increasing efforts to address atrial fibrillation with curative ablative strategies . Ablation approaches for atrial fibrillation focus on two alternate strategies : ablation of the substrate for initiation and ablation of the substrate for maintenance of atrial fibrillation . It has been demonstrated that atrial fibrillation may be initiated by repetitive atrial premature beats originating from a single focus . These ectopic foci can be mapped and ablated , thereby removing the substrate for initiation of atrial fibrillation . Most often , these atrial premature beats arise from the pulmonary veins . A challenge in trying to ablate the trigger is actually having enough spontaneous activity from the said focus throughout the electrophysiologic study . To sidestep the need of mapping , pure anatomic approaches are currently under investigation to electrically isolate the pulmonary veins from the atrial myocardium by circumferential lesions . In patients without a defined trigger for atrial fibrillation , efforts were made to ablate the substrate for maintenance of atrial fibrillation . Strong evidence exists that atrial fibrillation is the result of multiple coexisting reentrant wavelets requiring a critical myocardial mass to perpetuate . Several working groups demonstrated that intraoperative compartmentalization of the myocardial tissue by surgical incisions or radiofrequency pulses is highly effective in preventing atrial fibrillation . Currently , attempts were made to reproduce the surgical technique using transveneous , catheter-based approaches . Though our knowledge of ablation techniques and technical prerequisites is continuously increasing , the difficulty to produce complete linear lesions in the left atrium and local thrombus formation at the ablation line are problems that are still not solved ."
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Herzschrittmachertherapie.9010s046.eng.abstr
|
Herzschrittmachertherapie.9010s046.eng.abstr
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[
{
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] |
[] |
[] |
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{
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}
] |
Herzschrittmachertherapie.9010s047.eng.abstr
|
Herzschrittmachertherapie.9010s047.eng.abstr
|
[
{
"id": "Herzschrittmachertherapie.9010s047.eng.abstr-passage-0",
"type": "abstract",
"text": [
"For frequent ventricular ectopic beats , currently , reassurance and pharmacological therapy are the mainstays of treatment . This study assesses the useful role of catheter ablation in eliminating frequent monomorphic ventricular ectopic beats in severely symptomatic patients . Catheter ablation was performed in 65 patients with frequent drug refractory ventricular ectopic beats . The site of origin of ventricular ectopic activity was accurately mapped by using pace mapping , earliest endocardial activation time , and unipolar mapping . In 5 patients a new non-contact mapping was additionally performed . The ectopic focus was located in the right ventricular outflow tract in 37 and in the left ventricle in 28 patients . Ventricular ectopic beats were successfully eliminated by catheter ablation in 49/65 patients ( 75% ) . During a mean follow up of 13 +/- 11 months , 9 of 49 successful ablated patients ( 18% ) had a recurrence . Radiofrequency catheter ablation can be successfully used to eliminate ventricular ectopic activity . It may , therefore , be a reasonable alternative for the treatment of severely symptomatic , drug resistant monomorphic ventricular ectopic activity ."
],
"offsets": [
[
0,
1196
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]
}
] |
[
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25,
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[] |
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Herzschrittmachertherapie.9010s058.eng.abstr
|
Herzschrittmachertherapie.9010s058.eng.abstr
|
[
{
"id": "Herzschrittmachertherapie.9010s058.eng.abstr-passage-0",
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"The Medtronic Thera/Thera-i ( and Kappa 400 ) pacemakers utilize a mode switching algorithm that switches from the DDD/R mode to the DDIR mode in the presence on an atrial tachyarrhythmia . To accomplish this , the pacemaker keeps track of a mean atrial rate ( MAR ) which is a weighted index of the atrial rate . Once the MAR is greater than the programmed mode switch rate the pacemaker mode switches to the nontracking mode . Because the algorithm weights faster atrial rates more heavily than slow atrial rates , the algorithm is sensitive to a wide variety of atrial tachyarrhythmias , including those with varying amplitudes . Additionally , the algorithm provides a long PVARP and a rate adaptive ( RA ) AV interval . These not only help ensure that a wide range of atrial rates will be detected , but may also limit the time the patient tracks at the upper rate before mode switching . In order to assess the effectiveness of the algorithm , the Thera-i provides detailed diagnostics which provide information on the date , time , duration , and rate of the mode switch episodes . Additionally , more detailed beat-to-beat information is provided for each episode which can help determine its appropriateness and can assist in making programming changes ."
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[] |
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Herzschrittmachertherapie.9010s067.eng.abstr
|
Herzschrittmachertherapie.9010s067.eng.abstr
|
[
{
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],
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}
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[] |
[] |
[] |
Herzschrittmachertherapie.9010s069.eng.abstr
|
Herzschrittmachertherapie.9010s069.eng.abstr
|
[
{
"id": "Herzschrittmachertherapie.9010s069.eng.abstr-passage-0",
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"Modern pacemaker therapy is considered to be a safe and reliable procedure in the treatment of symptomatic and/or prognostically important bradycardiac arrhythmias . About every sixth patient dies of sudden cardiac death in the period after pacemaker implantation , whereby death is in the vast majority of cases ascribable to progression of underlying cardiac disease . But in the recent past , it has become clear that permanent electrostimulation of the heart may involve the risk of elicitation and/or aggravation of live-threatening ventricular arrhythmias . Especially in advanced myocardial damage , stimulation-related R-on-T phenomena , \" short-long \" sequences and sensing failure , for example during ventricular arrhythmias or transient myocardial ischemia may elicit secondary life-threatening tachyarrhythmias . In light of the fact that this cause of sudden cardiac death is avoidable in such pacemaker-related events , a better understanding of the pathomechanisms involved and appropriate awareness would be the best precondition of making modem pacemaker therapy not only reliable but especially safer for the patient ."
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[] |
[] |
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Herzschrittmachertherapie.9010s072.eng.abstr
|
Herzschrittmachertherapie.9010s072.eng.abstr
|
[
{
"id": "Herzschrittmachertherapie.9010s072.eng.abstr-passage-0",
"type": "abstract",
"text": [
"Background : According to literature , 30-60 % of pacemaker patients suffer from paroxysmal atrial fibrillation ( PAF ) . As rapid tracking of PAF may cause severe symptoms in patients with dual chamber pacemakers , refined algorithms providing AV synchronous pacing during periods of sinus rhythm and preventing high ventricular rates during PAF are highly desirable . Aim and method : This comprehensive paper introduces a new mode switching ( MS ) algorithm which uses either a fixed ( Inos2CLS) or programmable ( Logos ) number of short intervals out of 8 consecutive atrial intervals to detect PAF . If the MS criterion is fulfilled , a switch from AV synchronous pacing to nontracking mode is automatically performed . The algorithm is described together with a discussion on optimization of the programming of parameters which may indirectly influence the MS sensitivity and specificity . Results : This MS concept maintains the high sensitivity and fast reactivity towards PAF of the \" mode conversion \" in Actros and Kairos pacemaker systems , preventing a long time delay between onset of PAF , detection of the arrhythmia , and switch to nontracking mode . In addition , adequeate sensing and short blanking periods in the new MS concept enable reliable MS . The occurrence of atrial oversensing should be tested , as it may lead to inappropriate MS . Programmability of the MS algorithm may be advantageous for individual programming with respect to the patients ' arrhythmia rate and atrial sensing performance , but the use of very restrictive or very liberal criteria should be avoided as both may lead to mode oscillations . Finally , examples of stored diagnostic data are presented to assess MS reliability , identify possible problems , and optimize MS function during follow-up ."
],
"offsets": [
[
0,
1799
]
]
}
] |
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] |
Herzschrittmachertherapie.9010s086.eng.abstr
|
Herzschrittmachertherapie.9010s086.eng.abstr
|
[
{
"id": "Herzschrittmachertherapie.9010s086.eng.abstr-passage-0",
"type": "abstract",
"text": [
"Catheter ablation is an established method to treat paroxysmal supraventricular tachyarrhythmias . However , the risks of catheter ablation have to bee weight against antiarrhythmic therapy . With catheter ablation AV-block III ° , pulmonary embolism , pericardial tamponade ( in some cases followed by death ) , arterial embolism as well as other complications have been described . Especially the long term consequences of prolonged fluoroscopy time are an increased risk for fatal malignancies in young patients . On the other hand the efficacy of antiarrhythmic therapy in patients with paroxysmal supraventricular tachycardia has been shown . The risk of proarrhythmia associated with the treatment with class 1 and class 3 antiarrhythmic drugs that has been documented in patients after mayocardial infarction and in heart failure patients cannot be transferred to patients without structural heart disease . It is concluded that drug therapy is still an important form of treatment in patients with paroxysmal supraventricular tachycardia ."
],
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0,
1047
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]
}
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Herzschrittmachertherapie.9010s093.eng.abstr
|
Herzschrittmachertherapie.9010s093.eng.abstr
|
[
{
"id": "Herzschrittmachertherapie.9010s093.eng.abstr-passage-0",
"type": "abstract",
"text": [
"Many small randomized studies with beta > -blockers in patients with chronic heart failure have been published in recent years . A large meta-analysis by Lechat combining 18 studies with 3023 patients showed a 32% reduction in mortality in patients treated with beta > -blockers . Mortality and hospitalization together were reduced by 37% . In 1998 two large randomized trials investigating Bisoprolol ( CIBIS II ) and Metoprolol ( MERIT-HF ) were finished . Both studies show a significant reduction in mortality in patients treated with beta > -blockers . The ongoing COMET study compares beta > 1-selective blockers like metoprolol with vasodilatative beta > -blockers like carvedilol in patients with chronic heart failure . Large clinical registries demonstrate clinical practicability of beta > -blocker treatment of patients with chronic heart failure . All patients with stabel chronic heart failure ought to be treated with beta > -blockers additional to a basic therapy with ACE inhibitors , diuretics , and digitalis . The beta > -blocker therapy regimen is to start with low doses and to increase the dose carefully : \" Start low and go slow \" ."
],
"offsets": [
[
0,
1158
]
]
}
] |
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IntensiveMedizin.00370007.eng.abstr
|
IntensiveMedizin.00370007.eng.abstr
|
[
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"The assessment of the impaired sympathetic-vagal balance provides in many disorders unique information concerning prognosis and treatment strategies . Especially the indications for using the heart rate variability analysis and the baroreflex sensitivity evaluation are well defined and proven in large prospective studies . The ventilatory and cardiac chemoreflex sensitivities are tools which could improve prediction of malignant cardiac arrhythmias and the prognosis of patients with advanced chronic heart failure . They are at this stage in the focus of intense research . Especially sepsis and MODS , as ICU-relevant disorders , are coupled with an impairment of autonomic function . Thus , the reduction of heart rate variability in such patients culminated in the loss of the nerval-humoral organ interaction ( \" uncoupling of biological oscillators \" ) hypothesis . This idea nowadays contributes to the pathophysiological concept of the clinical manifestations of sepsis and MODS ."
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[] |
[] |
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IntensiveMedizin.00370019.eng.abstr
|
IntensiveMedizin.00370019.eng.abstr
|
[
{
"id": "IntensiveMedizin.00370019.eng.abstr-passage-0",
"type": "abstract",
"text": [
"Advances in the surgical management of children , in particular neonates with complex and previously lethal congenital heart disease has led to a dramatic improvement in survival . Nevertheless , complex heart surgery is sometimes associated with significant multi-organ disorders . These may originate from an adverse pre-operative condition , from post-operative circulatory failure and from the adverse effects of long-term intensive supportive therapy . Therefore , each neonate with a congenital heart defect must have a thorough workup for associated or genetically determined defects . Metabolic disturbances must be corrected before surgery as far as possible . After surgical correction , organ failure is almost exclusively the result of circulatory failure . Cardiac tamponade , also tamponade without pericardial fluid but by swelling of the heart within the pericardium and closed thorax , must be considered . If circulatory instability persists in spite of adequate heart rate and rhythm , optimized pre- and afterload and optimal myocardial support , the patient must be scrutinized for residual heart defects and surgical reintervention may be strongly indicated . Respiratory failure may be a sign of heart failure . Renal support therapy may facilitate fluid management and may be a lifesaving bridge to total or partial recovery of renal function , provided heart failure is overcome . However , there is no evidence for routine renal replacement therapy to prevent postsurgical multi-organ failure . Children with congenital heart defects can be treated appropriately only within a multidisciplinary team in which pediatric intensivists , heart surgeons , cardioanaesthesiologists , and pediatric cardiologists can rely on a high standard of care from other pediatric disciplines ."
],
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0,
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[] |
[] |
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IntensiveMedizin.00370044.eng.abstr
|
IntensiveMedizin.00370044.eng.abstr
|
[
{
"id": "IntensiveMedizin.00370044.eng.abstr-passage-0",
"type": "abstract",
"text": [
"After two days of abstinence of prior alcohol abuse , a 48 year old man fell unobserved and was unconscious for a short time . On admission he was reoriented but showed a persisting psychomotoric restlessness . There was no focal neurological deficit , especially no headache nor meningism . Diagnosis of an alcohol withdrawal seizure was made . A CT-scan unexpectedly showed a severe basal subarachnoid hemorrhage . Arteriography revealed an aneurysm of the anterior communicating artery which was quickly operated . After surgery the patient recovered completely ."
],
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[
0,
566
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]
}
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[] |
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] |
IntensiveMedizin.00370048.eng.abstr
|
IntensiveMedizin.00370048.eng.abstr
|
[
{
"id": "IntensiveMedizin.00370048.eng.abstr-passage-0",
"type": "abstract",
"text": [
"We take this case-report of a 37 year old patient who had a rupture of the thoracic aorta as a result of traffic accident , to discuss how this injury can be managed in a hospital with no possibility of extra-corporeal circulation , and which specific risks can appear by using the simple clamping technique for aortic repair surgery ."
],
"offsets": [
[
0,
335
]
]
}
] |
[
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38,
41
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{
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]
}
] |
[] |
[] |
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IntensiveMedizin.00370053.eng.abstr
|
IntensiveMedizin.00370053.eng.abstr
|
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"Intravenous thrombolysis has become a standard in treatment of acute myocardial infarction . Efficacy of thrombolysis is strictly time dependent . It has been shown in several studies that the most benefit in terms of myocardial salvage and short- and long-term mortality is achieved with initiation of therapy within the first 60-90 minutes after onset of symptoms . Nearly exlusively , prehospital initiation of thrombolysis makes it possible to take advantage of this early time window . Moreover , randomized studies yielded a better outcome when a time gain of > =90 minutes was achieved . Since it has been shown that prehospital diagnosis of an acute myocardial infarction is reliable and out-of-hospital initiation of therapy has no additional specific risk , patients seen within the first 60-90 minutes after onset of symptoms or for whom a relevant time gain > =90 minutes can be expected are ideal candidates for , and therefore should receive , prehospital thrombolysis . In places where acute intervention ( e.g. , PTCA ) is available , protocols should be developed which take the specific time windows into consideration ."
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[] |
[] |
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IntensiveMedizin.00370062.eng.abstr
|
IntensiveMedizin.00370062.eng.abstr
|
[
{
"id": "IntensiveMedizin.00370062.eng.abstr-passage-0",
"type": "abstract",
"text": [
"The introduction of \" early defibrillation \" by emergency technicians ( nonphysicians ) in Germany led to a very emotional and controversial discussion , since the use of a defibrillator had previously been restricted to physicians . \" Early defibrillation \" by definition signifies immediate defibrillation by first-arriving nonphysician rescuers . The alternative term is EMT ( emergency medical technician ) defibrillation . The term early defibrillation is suggestive of very early defibrillation . Even if this is seldom achieved in real life , it points to the fact that this means the earliest possible defibrillation . \" Early defibrillation \" is closely related to the chain of survival concept . The clearly structured optimized chain of survival , a tiered emergency medical system , is a precondition for an effective early defibrillation program . In the tiered system of densely stationed , basically qualified rescue personnel , basic life support including defibrillation with semi-automatic defibrillators is started until the emergency physician ( in other countries paramedics ) arrives at the scene . Only a few hours of training are necessary to enable safe and effective use of semi-automatic defibrillators by basic rescue personnel . The use of semi-automatic defibrillators in early defibrillation programs is recommended by the American Heart Association and by the European Resuscitation Council . Even the use of these devices by minimally trained non-rescue personnel ( e.g. , policemen and other security personnel ) is a second-step recommendation ."
],
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IntensiveMedizin.00370069.eng.abstr
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IntensiveMedizin.00370069.eng.abstr
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IntensiveMedizin.00370113.eng.abstr
|
IntensiveMedizin.00370113.eng.abstr
|
[
{
"id": "IntensiveMedizin.00370113.eng.abstr-passage-0",
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"text": [
"We evaluated changes in brain tissue oxygen pressure ( ptiO2) and global cerebral blood flow ( CBF ) during cardiopulmonary bypass ( CPB ) with deep hypothermic circulatory arrest ( DHCA ) in ten anesthetized New Zealand White rabbits ( body weight 2.5 +/- 0.5 kg ) . CBF [ hydrogen desaturation ( clearance ) -technique ) and ptiO2 ( Licox-microsensor ) right frontoparietal cortex ] were determined . After median sternotomy , the animals were placed on CPB ( standard roller pump , nonpulsatile , -stat acid-base management , perfusion flow of 180-200 mL/kg/min , right atrial and aortic cannulation ) for induction of DHCA by cooling to 15 °C rectal temperature ( 1 °C per minute ) . Rewarming period was started after 60 minutes of circulatory arrest and the rabbits were weaned from CPB without the use of any inotropic or vasoactive support . Under baseline conditions , ptiO2 was 38 +/- 5 mmHg and did not change significantly before DHCA . During DHCA the ptiO2 decreased within 15 minutes to 14 +/- 5 mmHg , after 30 minutes to 5 +/- 1 mmHg and after 40 minutes to zero . Neither the ptiO2 nor CBF recovered fully following restoration of bypass flow and reperfusion : ptiO2 ( 25 +/- 4 mmHg vs. baseline : 38 +/- 5 mmHg , p 0.05 ) and CBF ( 43 +/- 8 vs. baseline : 68 +/- 11 ml/100 g/min , p 0.05 ) were significantly reduced . Arterial and jugular-venous lactate levels increased after rewarming ( p 0.05 ) and corresponded to the appearance of a anaerobic metabolism . These data demonstrate significantly decreased levels of ptiO2 ( brain tissue oxygenation ) and CBF ( oxygen supply ) during and after rewarming from DHCA . The induced impairment of recovery persists after rewarming and generates a temporary low-flow situation with delayed brain tissue reoxygenation on the cellular/mitochondrial level . Thus , a direct influence on brain functional recovery by the active cooling and rewarming process about the bloodstream during CPB , resulting in disturbed tissue blood redistribution , mitochondrial dysfunction and/or excessive cerebral oxygen consumption ( compensation of an oxygen debt ) is a possible explanation ."
],
"offsets": [
[
0,
2141
]
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] |
[] |
[] |
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] |
IntensiveMedizin.00370121.eng.abstr
|
IntensiveMedizin.00370121.eng.abstr
|
[
{
"id": "IntensiveMedizin.00370121.eng.abstr-passage-0",
"type": "abstract",
"text": [
"After a gynecological operation under therapy with unfractionated and low molecular weight heparin , a 63 year old patient developed right-sided ascending pelvic thrombosis with multiple pulmonary embolism and infarction pneumonia , septic-toxic circulatory failure , and thrombocytopenia . Heparin-associated thrombocytopenia ( HAT ) type II was diagnosed . Because of contraindications against thrombolysis a cava-filter was implanted , heparin therapy was stopped , and anticoagulation with recombinant hirudin was started . Inspite of this , an arterial thrombosis of the A. femoralis superficialis developed and had to be treated surgically . From this time on , no further thromboembolic complications were noticed . Overlapping coumarin therapy was begun . Due to ubiquitous coumarin-necrosis , rapid progressive toxic circulatory failure with disseminated intravascular coagulation ( DIC ) developed two days after terminating hirudin therapy necessitating high dose catecholamine therapy . A second course of hirudin resulted in complete restitution of the coumarin-necrosis without the need for re-operation . Subsequent coumarin-therapy , which was gradually increased over two weeks , was without further complications . Thus , hirudin appears to be a new and safe alternative to a therapy with the heparinoid danaparoid in HAT type II with fulminant thromboembolic complications and especially in coumarin-necrosis with critical septic-toxic circulatory failure and DIC ."
],
"offsets": [
[
0,
1484
]
]
}
] |
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] |
[] |
[] |
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IntensiveMedizin.00370127.eng.abstr
|
IntensiveMedizin.00370127.eng.abstr
|
[
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"We report on a 55-year old patient who presented with a four month history of intermittent left thoracic painful attacks which radiated in the left arm . Both normal 12 lead electrocardiogram and treadmill stress tests showed no significant ST changes . A thallium-201 scintigraphy afterwards disclosed a non-transmural septal ischemia . The consecutively performed diagnostic catheterization revealed a severe , almost pouch-like proximal aneurysm of the right coronary artery with a maximal diameter of 15-20 mm as well as an aneurysmatic modified left coronary artery and an impaired left ventricular function ( EF 49% ) . In the absence of coronary artery stenosis , the patient was treated conservatively with an ACE inhibitor ( lisinoprile 20 mg/day ) under accompanying effective anticoagulant therapy with coumadin . With this strategy the patient has been asymptomtic during the eight month follow-up period ."
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[] |
[] |
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] |
IntensiveMedizin.00370139.eng.abstr
|
IntensiveMedizin.00370139.eng.abstr
|
[
{
"id": "IntensiveMedizin.00370139.eng.abstr-passage-0",
"type": "abstract",
"text": [
"For patients with dilative cardiomyopathy ( DCM ) , the prognosis is highly unfavorable , even under conditions of optimal medication . At present , there is no option for causal therapy . Since there is increasing evidence that modifications of the immune system accompanied by the production of autoantibodies , e.g. , against 1 ad-renergic or muscarinergic receptors , are involved in the pathogenesis of DCM , the elucidation of the possible functional significance of these autoantibodies has attracted increasing interest . In addition to the role of autoantibodies as markers for an autoimmune process , discussion of the possible pathogenetic mechanisms has centered on direct toxicity as well as on negative influencing of myocardial contractility and energy metabolism . The effects gained through removal of autoantibodies by immunoadsorption therapy for DCM patients sheds light on the functional importance of autoantibodies in this syndrome . The principle of this form of therapy is based on the binding of circulating antibodies to sepharose columns , to which polyclonal antibodies against human immunoglobulin are linked . A pilot study conducted among DCM patients disclosed that immunadsorption took place in simultaneous conjunction with a reduction in the immunoglobulin level and with significant hemodynamic and clinical improvement . These results may be interpreted as indicating that autoantibodies play an active role in DCM and that their removal by immunadsorption possibly represents a highly promising future therapeutic concept ."
],
"offsets": [
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0,
1562
]
]
}
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[] |
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] |
IntensiveMedizin.00370166.eng.abstr
|
IntensiveMedizin.00370166.eng.abstr
|
[
{
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"text": [
"Nitric oxide ( NO ) is a short-lived effector molecule which is produced from L-arginine by several NO synthase ( NOS ) isoforms . Physiologically , small amounts of NO are produced by an endothelial constitutive NOS ( ecNOS ) , which is involved in the regulation of vascular tone and blood flow distribution . On stimulation by bacterial products and various cytokines , an inducible NOS ( iNOS ) becomes diffusely expressed , producing large amounts of NO for extended periods of time , which are implicated in the pathogenesis of septic shock . The pharmacological inhibition of NO synthesis has been , therefore , proposed as a new therapy in this setting . Unfortunately , such inhibition has been frequently reported to be detrimental , and recent evidence reveals that this deleterious potential is a consequence of ecNOS blockade by nonselective NOS inhibitors . Thus , interest is now focusing in the identification of compounds able to selectively inhibit iNOS activity . Although the effects of such selective agents have been only poorly investigated so far , they appear extremely promising . Indeed , in various animal models of septic shock , selective iNOS inhibitors have produced a marked improvement in hemodynamics , tissue oxygenation , and organ function , leading to a reduced mortality . These favorable results , which markedly contrast with the deleterious influence of nonselective NOS inhibitors in similar conditions , suggest that selective iNOS inhibitors might become useful adjuncts to septic shock therapy in the future ."
],
"offsets": [
[
0,
1556
]
]
}
] |
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[] |
[] |
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IntensiveMedizin.00370176.eng.abstr
|
IntensiveMedizin.00370176.eng.abstr
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"Abstract The term acute exacerbation of chronic obstructive pulmonary disease ( COPD ) reflects an acute worsening of the stable state with an increase in dyspnea , cough , and count or purulence of sputum . The management of an acute exacerbation is guided mainly clinical severity which has implications on the decision of outpatient management , hospital management or intensive care treatment . Cardiopulmonary comorbidity and the number of previous exacerbations are prognostic factors . The first-line therapy of each exacerbation is the intensification of drug-treatment with 2-agonists and anticholinergics . Systemic steroids as a short-term course are advocated if hospital-treatment is necessary . Infections of the respiratory tract are a frequent cause of acute exacerbations . However , a colonization with potential pathogenic microorganisms is found in many patients in the stable state . Antibiotic treatment is justified if cardiopulmonary comorbidity and frequent previous exacerbations are present . The severity of airflow obstruction and the frequency of previous exacerbations are linked to the spectrum of the underlying microorganisms . This should be borne in mind for the choice of the antimicrobiotic treatment . Noninvasive ventilation in severe exacerbation is able to improve gas-exchange and to reduce the work of breathing . As a consequence the number of intubations and the attributable morbidity and mortality are reduced . If invasive mechanical ventilation is necessary , the potential of dynamic hyperinflation in acute exacerbation has to be considered ."
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[] |
[] |
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IntensiveMedizin.00370195.eng.abstr
|
IntensiveMedizin.00370195.eng.abstr
|
[
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"text": [
"The situation of intensive care units ( ICU ) in Germany was analyzed by a national survey . Questionnaires consisting of multiple-choice and short-answer questions were sent to ICUs of university hosptitals , hospitals with > 1000 beds , 500-1000 beds , and hospitals with 500 beds separately with regard to the different disciplines ( anesthesia ICUs , surgical ICUs , cardiac surgical ICUs , neurosurgical ICUs , neurological ICUs , mixed-surgical ICUs , internal ICUs , interdiscipline ICUs ) ."
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[
0,
498
]
]
}
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] |
[] |
[] |
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IntensiveMedizin.00370206.eng.abstr
|
IntensiveMedizin.00370206.eng.abstr
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[
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"The measures taken in intensive care medicine are rated differently by the patients , their family , and personnel . A lack of understanding for intensive care therapy can lead to a negative attitude towards intensive care medicine , which in turn makes an impression on public opinion , and disturbs the reputation of the co-workers in intensive care medicine . To form an objective view , we carried out a survey of 40 co-workers ( 11 physicians , 23 from the nursing staff , and 6 ancillary personnel ) regarding the medical technology , the environment in the unit , general medical questions , and the extent of intensive care therapy . The length of employment in the intensive care unit ranged from 1-240 months ( median 18 months ) , the ages ranged from 21 to 53 years ( median 30 years ) . Of those questioned 73% found intensive care medicine in its current form to be purposeful : 100% of the physicians and only 57% of the nursing staff were of this opinion . Only 9% of the physicians believed the equipment to be fear-inducing for the patients ; in contrast , 61% of the nursing staff believed this to be true . The noise level was rated as very disturbing by 65% of the nursing staff and 45% of the physicians . Only 22% of the nursing staff believed that the patients felt comfortable and protected on the intensive care unit ; 48% felt that they were unhappy or even miserable . Of the physicians 46% believed that the patients were comfortable . Of the nursing staff 100% were of the opinion that for the deceased patients , organ substitution therapy had continued too long . On the other hand , only 45% of the residents shared this opinion . The medical staff rated the intensive care measures as purposeful , less disturbing for the patients and more effective than did the nursing staff . In many cases , the nursing staff as a group exhibited a contrary and negative opinion . This could possibly be caused by insecurity , lack of information and lack of successful experiences . Next to patient outcome , the competent explanation and information regarding the disease and prognosis and the recurrent communication within the intensive care team , with respect to diagnostic and therapeutic measures are the deciding factors in the opinion formation regarding intensive care medicine ."
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] |
[] |
[] |
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] |
IntensiveMedizin.00370213.eng.abstr
|
IntensiveMedizin.00370213.eng.abstr
|
[
{
"id": "IntensiveMedizin.00370213.eng.abstr-passage-0",
"type": "abstract",
"text": [
"Late onset of adult Still's Disease is characterized by fever , arthralgia , typical rash and leukocytosis as major criteria , and sore throat , lymphadenopathy and/or splenomegaly , liver dysfunction and the absence of rheumatoid factor and antinuclear antibody as minor criteria . A 20 year old man presented with tonsillitis followed by perimyocarditis , which was borderline by myocardial biopsy , typical ECG changes with negative T-waves in the left precordial leads and a slightly reduced left ventricular function echocardiographically . Because of high temperature and neutrophilia he was initially treated for bacterial infection with different regimens of antibiotics . In the clinical follow up he developed other symptoms like elevation of liver enzymes and arthralgia . These symptoms together with persistent fever , elevated leukocytes and a severe inflammatory process despite antibiotic therapy and negative rheumatoid factor as well as negative antinuclear factors led to the diagnosis of Still's Disease after exclusion of a hematological disease by bone marrow examination . After starting high dose corticoid therapy , the fever decreased promptly and patient feels well since then . This case shows that in patients initially presenting with perimyocarditis after upper respiratory tract infection , the very rare differential diagnosis of late onset of Still's Disease has to be contemplated ."
],
"offsets": [
[
0,
1417
]
]
}
] |
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] |
[] |
[] |
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] |
IntensiveMedizin.00370226.eng.abstr
|
IntensiveMedizin.00370226.eng.abstr
|
[
{
"id": "IntensiveMedizin.00370226.eng.abstr-passage-0",
"type": "abstract",
"text": [
"The limited success of thrombolytic therapy and the high percentage of patients who have to be excluded from lysis has resulted in the alternative application of primary PTCA in acute myocardial infarction . Randomized studies so far available have shown a significant decrease of hospital mortality by primary PTCA as compared to thrombolysis . Adjuvant stent implantation and a wider administration of glycoprotein IIA/IIIB inhibitors may further reduce mortality . For logistic and financial reasons however , not all patients with acute myocardial infarction can benefit from this therapeutic approach in spite of the high density of health care in Germany . Primary PTCA in acute myocardial infarction should be left to experienced centres and investigators . Of utmost importance is a reduction of the present \" onset-to-opening \" times by information campaigns , an improved triage , use of transportation times for pre-hospital lysis and improved thrombolytic agents ."
],
"offsets": [
[
0,
976
]
]
}
] |
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] |
[] |
[] |
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IntensiveMedizin.00370239.eng.abstr
|
IntensiveMedizin.00370239.eng.abstr
|
[
{
"id": "IntensiveMedizin.00370239.eng.abstr-passage-0",
"type": "abstract",
"text": [
"Guillain-Barré syndrome ( GBS ) is an infection-triggered , immune-mediated demyelinating inflammation of the peripheral nerves . It often requires treatment in an intensive care unit because of progressive weakness with impairment of respiratory muscle function and involvement of the autonomic nervous system leading to life-threatening dysautonomia . The discernment and prophylaxis of complications in due time needs special expenditure of nursing care . Clinical state , the vital capacity , and blood gases have to be observed regularly to discern the need of intubation and mechanical ventilation ( up to 25% of the patients ) . Dysautonomia may cause blood pressure fluctuations with severe hypertension or hypotension as well as severe tachycardias or bradycardias so that continuous electrocardiographic monitoring , frequent measurements of blood pressure , and readiness for cardiopulmonary resuscitation including transcutaneous demand pacing are recommended . Tetraplegic and therefore immobilized patients are at risk for several complications that can be prevented by adequate nursing , positioning , mobilization , chest physiotherapy , and prophylaxis for deep vein thrombosis . If cranial nerves are involved , the danger of dysphagia and aspiration has to be taken into account , enteral nutrition may require a nasogastric or nasoduodenal probe . Dysautonomia often includes impairment of bladder and intestinal functions , which therefore have to be controlled regularly and to be supported if necessary . Nursing of the alert teraplegic GBS patient needs special empathy and should include psychological support ; the desire for pharmacological anxiolysis , sedation or pain relief also has to be taken into account . Besides specific therapeutic measures such as intravenous immunoglobulin or/and plasmapheresis , adequate nursing care can contribute significantly to improve the outcome of patients with GBS ."
],
"offsets": [
[
0,
1934
]
]
}
] |
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}
] |
[] |
[] |
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] |
IntensiveMedizin.00370257.eng.abstr
|
IntensiveMedizin.00370257.eng.abstr
|
[
{
"id": "IntensiveMedizin.00370257.eng.abstr-passage-0",
"type": "abstract",
"text": [
"The morphological changes in the lung in ARDS ( adult respiratory distress syndrome ) require an appropriate adaptation of the mechanical ventilation . In this review different options of modifying mechanical ventilation are shown . The pathophysiological mechanisms of ARDS and their partially resulting treatment modalities are explained . They consist of reducing inspiratory pressure and tidal volume , the application of positive end-exspiratory pressure ( PEEP ) and ventilation in prone position . The indications and contraindications of permissive hypercapnia and nitric oxide ( NO ) are discussed . As another therapeutic approach , the superimposed spontaneous breathing and new modes of ventilatory support are discussed ."
],
"offsets": [
[
0,
734
]
]
}
] |
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IntensiveMedizin.00370265.eng.abstr
|
IntensiveMedizin.00370265.eng.abstr
|
[
{
"id": "IntensiveMedizin.00370265.eng.abstr-passage-0",
"type": "abstract",
"text": [
"Acute pulmonary embolism is still a challenging field in clinical practice . In the recently published MAPPET study the traditional diagnostic approach using ventilation-perfusion scanning followed by pulmonary angiography was replaced by a more flexible algorithm focusing on transthoracic echocardiography in the majority of cases . Moreover , helical computed tomography has gained importance in the diagnostic confirmation of acute pulmonary embolism . Treatment options are still based on clinical stages . For hemodynamically stable patients anticoagulation is adequate as first line therapy . However , as evident from the MAPPET registry even normotensive patients at presentation with echocardiographic signs of right ventricular dysfunction significantly benefit from primary fibrinolytic therapy . Additionally , the MAPPET registry outlines risk factors for increased in-hospital mortality of acute pulmonary embolism , i.e. , syncope , hypotension , history of congestive heart failure , and chronic pulmonary disease . Overall , according to the MAPPET data it seems evident that fibrinolytic therapy lowers mortality in patients younger than 65 years and , even in cardiogenic shock , catheter fragmentation or surgical embolectomy can be avoided in most cases with fibrinolytic treatment strategies ."
],
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] |
[] |
[] |
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] |
IntensiveMedizin.00370273.eng.abstr
|
IntensiveMedizin.00370273.eng.abstr
|
[
{
"id": "IntensiveMedizin.00370273.eng.abstr-passage-0",
"type": "abstract",
"text": [
"In the majority of ventilated patients endotracheal intubation is required only for a short time period . However , about 20% of the patients require prolonged mechanical ventilation . Apart from dysfunction of the central nervous system with a reduced respiratory drive , the vast majority of patients being difficult to wean suffer from either an increased load or a decreased capacity of their respiratory muscles . Furthermore , beside compromised respiratory mechanics other causes of difficult weaning are , e.g. , left heart failure , inadequate sedation , neuropsychiatric issues , malnutrition and aspiration . The mere application of a consistent weaning strategy ( independent from its concrete content ) leads to an improved success rate . In this article three essential aspects of a weaning strategy are dealt with : 1 ) The concept of interventions ( in particular focusing on mechanical ventilation modes unloading respiratory muscles ) , 2 ) pathophysiologically based parameters to predict weaning success or failure and 3 ) organisation of the T-tube trials . A new approach in weaning of long-term ventilated patients is non-invasive mechanical ventilation ( NMV ) . Compared to invasive mechanical ventilation NMV aims at reducing weaning time , decreasing complication rate and improving prognosis . Finally , the last section addresses terminal weaning ."
],
"offsets": [
[
0,
1377
]
]
}
] |
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IntensiveMedizin.00370284.eng.abstr
|
IntensiveMedizin.00370284.eng.abstr
|
[
{
"id": "IntensiveMedizin.00370284.eng.abstr-passage-0",
"type": "abstract",
"text": [
"The contribution of inhalation injury to the mortality of severely burned patients is very high ( approximately 80% of the fatalities ) . The injury to the tracheobronchial system with concomitant burn injury leads to a progressive lung edema . The edema and the state of systemic inflammatory response syndrome ( SIRS ) in trauma patients favours the incidence of an acute respiratory distress syndrome ( ARDS ) which is likewise afflicted with a mortality of 20-90% . The cause for the development of an ARDS is a deficiency of lung surfactant proteins . The lack of surfactant leads to an increase of surface tension , alveolar collapse , rising airway resistance and a decrease of the lungs ' compliance . This situation aggravates the airway obstruction and formation of atelectases caused by edema . Due to the SIRS , the surfactant system is further compromised by inflammatory degradation and inhibition . The lung injury with following ARDS builds the foundation for life threatening multiple organ failure ( MOF ) . The therpeutic approach to ARDS is limited and consists of pressure controlled ventilation , permissive hypercapnia , patient positioning , extracorporeal membrane oxygenation and the treatment of the underlying disease , in this case the immediate excision of the burn wounds . Results from animal experiments and uncontrolled clinical studies indicate that the patient with inhalation injury could benefit from high dose Ambroxol treatment or hyperbaric oxygenation . Furthermore , inhalative corticosteroid treatment is undisputed but not the systemic approach . There is no effective specific pharmacologic therapy of an inhalation injury following ARDS . In our study on four severely burned patients with inhalation injury and ARDS , we were able to demonstrate for the first time that intrabronchial application of a bovine surfactant preparation produces a sudden , and in some cases lasting , improvement in gas exchange . The clinical course of ARDS was influenced to avoid a state of no return with complications such as MOF and the high risk for an early fatal outcome . In view of the results the use of natural/recombinant surfactant in combination with a systemic antiinflammatory therapy of the capillary leak , as an emergency measure , seems to be a promising approach in cases of inhalation injury and merits further studies ."
],
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] |
[] |
[] |
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IntensiveMedizin.00370293.eng.abstr
|
IntensiveMedizin.00370293.eng.abstr
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"Based on recent reviews on the management of patients with status asthmaticus , the authors present their interpretation of the literature and clinical experience . Medical treatment with -agonists , steroids , aminophyllin and other bronchodilators ( ketamine , anesthetic gases ) and intensive care procedures ( fluid management , heliox , bronchial lavage ) are reviewed mechanical measures as mechanical hypoventilation , non-invasive ventilation and extracorporeal membrane oxygenation and cardiopulmonary bypass are discussed . Accepting status astmaticus as a life-threatening situation and acting in medical responsibility in the outlined way will provide successful management of patients with status asthmaticus ."
],
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0,
723
]
]
}
] |
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] |
[] |
[] |
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] |
IntensiveMedizin.00370298.eng.abstr
|
IntensiveMedizin.00370298.eng.abstr
|
[
{
"id": "IntensiveMedizin.00370298.eng.abstr-passage-0",
"type": "abstract",
"text": [
"Aspiration of toxic substances , foreign material , bacterially contaminated secretions , or water ( near-drowning ) either immediately leads to cessation of respiration or to impaired ventilation due to airway obstruction , it causes hypoxia due to surfactant dysfunction , and pulmonary infection might develop . Respiratory insufficiency is the resulting consequence which needs immediate and appropriate therapy and intervention . The knowledge of risk factors that promote aspiration injury is important for its prevention and limitation . Mortality varies between 3 and 70% depending on patients studied , and on the nature and amount of aspirated material . The major cause of death is acute respiratory failure . The onset of injury to the lung after aspiration is very rapid . Therefore , therapeutic interventions like bronchoscopy are often too late . More importantly , oxygenation should be monitored continuously for timely institution of mechanical ventilation . Antibiotics should not be given routinely but a calculated regime is neccessary when signs of infection develop . Prognosis in near-drowning considerably depends on early rescue and successful resuscitation . A rapid onset of cerebral hypothermia during the accident can help to increase the ischemic tolerance of the brain and makes it neccessary to continue advanced life support until rewarming of the near-drowning victim . Anticipation of individual outcome in unconscious patients is difficult . One third of them survive with a moderate to severe neurologic damage . The overall mortality of near-drowning is about 11% . Pathophysiological aspects , diagnostic procedures , pratical management and possible prophylaxis of aspiration injuries will be discussed ."
],
"offsets": [
[
0,
1746
]
]
}
] |
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[] |
[] |
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IntensiveMedizin.00370307.eng.abstr
|
IntensiveMedizin.00370307.eng.abstr
|
[
{
"id": "IntensiveMedizin.00370307.eng.abstr-passage-0",
"type": "abstract",
"text": [
"Adult respiratory distress syndrome ( ARDS ) is characterized by extended inflammatory processes in the lung microvascular , interstitial and alveolar compartments , resulting in vasomotor disturbances , plasma leakage , cell injury and complex gas exchange disturbances . Abnormalities of the alveolar surfactant system have since long been implicated in the pathogenetic sequelae of this life-threatening syndrome . This hypothesis is supported by similarities in pulmonary failure between patients with ARDS and preterm babies with infant respiratory distress syndrome ( IRDS ) , which is known to be triggered primarily by a lack of surfactant material . Mechanisms of surfactant alterations in ARDS include : lack of surface-active compounds , changes in the relative composition of the surfactant constituents , alteration of the extracellular surfactant subtype distribution , inhibition of surfactant function by plasma protein leakage , and damage/inhibition of surfactant compounds by inflammatory mediators . Alterations in alveolar surfactant function may well contribute to a variety of pathophysiological key events encountered in ARDS . These include decrease in compliance , ventilation-perfusion mismatch including shunt-flow due to altered gas flow distribution ( atelectasis , partial alveolar collapse , small airway collapse ) and lung edema formation . Persistent atelectasis of surfactant-deficient and , in particular , fibrin-loaded alveoli may represent a key event to trigger fibroblast proliferation and fibrosis in late ARDS ( collapse induration ) . Overall , the presently available data on surfactant abnormalities in ARDS lend credit to therapeutic trials with transbronchial surfactant application . Accordingly , acute improvement of gas exchange was encountered in two recently performed pilot studies addressing the safety and efficacy of a transbronchial application of large quantities of exogenous surfactant material . In parallel to a far reaching , but yet not complete restoration of \" physiological \" surfactant properties in BALF , re-opening of formerly collapsed lung regions with concomitant reduction of intrapulmonary shunt flow was noticed . Although not the primarily goal in these pilot studies , a tendency towards lower mortality in the surfactant treatment groups was noted . At present , a controlled study enrolling higher patient numbers is being performed to probe the impact of a transbronchial surfactant administration on the outcome of ARDS patients ."
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] |
IntensiveMedizin.00370321.eng.abstr
|
IntensiveMedizin.00370321.eng.abstr
|
[
{
"id": "IntensiveMedizin.00370321.eng.abstr-passage-0",
"type": "abstract",
"text": [
"Venous thromboembolism remains a therapeutic challenge . Without adequate treatment , acute pulmonary embolism has a fatality rate of up to forty percent that can be reduced to less than ten percent when the diagnosis is made correctly and prompt treatment is instituted . Novel diagnostic testing algorithms now permit a reduction of diagnostic errors regarding the presence or absence of venous thromboembolism . This article reviews the diagnostic tools available to detect acute or chronic pulmonary embolism and describes diagnostic strategies that have been evaluated in clinical trials ."
],
"offsets": [
[
0,
594
]
]
}
] |
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] |
[] |
[] |
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IntensiveMedizin.00370334.eng.abstr
|
IntensiveMedizin.00370334.eng.abstr
|
[
{
"id": "IntensiveMedizin.00370334.eng.abstr-passage-0",
"type": "abstract",
"text": [
"Most cases of uncomplicated primary or secondary spontaneous pneumothorax as well as pneumothoraces caused by accidental puncture of the pleura can be managed by insertion of a small-lumen catheter . In contrast , a large bore chest tube is indicated in complicated pneumothorax . Life-threatening tension pneumothorax has to be diagnosed quickly on clinical grounds and must be decompressed immediately . Hemothorax due to thoracic or abdominal trauma may cause massive blood loss and should be treated rapidly by chest tube or thoracotomy . Spontaneous hemothorax should also be drained and warrants careful diagnostic evaluation . Any physician in a respiratory or medical intensive care unit should be trained in the management of pneumothorax and hemothorax ."
],
"offsets": [
[
0,
764
]
]
}
] |
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},
{
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] |
[] |
[] |
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] |
IntensiveMedizin.00370341.eng.abstr
|
IntensiveMedizin.00370341.eng.abstr
|
[
{
"id": "IntensiveMedizin.00370341.eng.abstr-passage-0",
"type": "abstract",
"text": [
"Altered mechanical properties of the chest wall may influence different aspects of respiratory function , such as ventilation , work of breathing , respiratory muscles , and gas exchange . Up to now , different methods have been used to study the static and dynamical properties of the chest wall , including the rapid airway occlusion and the forced oscillation technique , but the role of the chest wall during passive and active ventilation has not been widely investigated due to the difficulties of compartmental analysis ."
],
"offsets": [
[
0,
528
]
]
}
] |
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] |
[] |
[] |
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IntensiveMedizin.00370352.eng.abstr
|
IntensiveMedizin.00370352.eng.abstr
|
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"This paper reviews respiratory muscle/circulation interaction in congestive heart failure . Respiratory muscle dysfunction consisting of both reduced pressure - generating capacity and reduced endurance is well documented in these patients . The mechanisms underlying its development and the potential consequences especially in the development of dyspnea are then presented . Not only are respiratory muscles dysfunctioning in these patients , but under specific circumstances they can impede the circulation , such as during weaning from mechanical ventilation . The underlying pathophysiology and the theoretical model explaining this interesting interaction is finally discussed ."
],
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0,
684
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[] |
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IntensiveMedizin.00370361.eng.abstr
|
IntensiveMedizin.00370361.eng.abstr
|
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"Like pain , dyspnea is a sensation that is not well understood and may have many causes . It is a frequent symptom in the emergency medical service and presents diagnostic problems and pitfalls in assessing severity . Dyspnea is a very common symptom in patients with cardiorespiratoy diseases . Diagnostic tests like pulse oximetry , blood gas analysis , capnometry or fiberoptic bronchoscopy often only allow a better assessment of severity but no diagnostic classification of dyspnea . Basic support includes clearing of upper airways , keeping the airways patent and establishment of artificial ventilation when necessary . Further therapeutic interventions depend on the suspected etiology of dyspnea ."
],
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[] |
[] |
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] |
IntensiveMedizin.00370374.eng.abstr
|
IntensiveMedizin.00370374.eng.abstr
|
[
{
"id": "IntensiveMedizin.00370374.eng.abstr-passage-0",
"type": "abstract",
"text": [
"Massive intrapulmonary bleeding is an alarming symptom that causes the patient to see his doctor immediately . In this situation diagnostic possibilities are limited due to the lack of time . The immediate treatment of the patient is necessary due to the life threathening airway obstruction . Initial treatment is according to the principles of emergency medicine . In order to treat the hemorrhage effectively , it is essential to differentiate between localized and generalized causes . Bronchoscopy is able to differentiate these possibilities ; furthermore it enables one to localize the site of the bleeding . Generalized pulmonary hemorrhage is mostly due to systemic diseases , which are treated according to the pathogenesis . Bronchial artery embolization has proven to be effective in the therapy of localized pulmonary hemorrhage . Ultimately the surgical resection of bleeding parts of the lung may be indicated ."
],
"offsets": [
[
0,
926
]
]
}
] |
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IntensiveMedizin.00370454.eng.abstr
|
IntensiveMedizin.00370454.eng.abstr
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] |
IntensiveMedizin.00370461.eng.abstr
|
IntensiveMedizin.00370461.eng.abstr
|
[
{
"id": "IntensiveMedizin.00370461.eng.abstr-passage-0",
"type": "abstract",
"text": [
"Pulmonary artery catheterization ( PAC ) is widely used for monitoring and optimization of hemodynamic therapy in critically ill patients . Despite its widespread use there is no clear evidence that morbidity and mortality can be reduced by this approach . In contrast , it has been suggested that PAC might increase mortality . Available data do not allow the definitive omission of PAC in medical intensive care , nor do they justify its widespread use . Possible reasons that might affect outcome are catheter-related complications and often misinterpretation due to insufficient knowledge about PAC . Open questions on the influence of PAC on outcome variables in critically ill patients have to be answered by conducting randomized controlled trials . Beforehand , knowledge about PAC has to be improved . As a consequence , PAC should be performed whenever a specific hemodynamic question arises that cannot be answered by clinical judgement or by less invasive means . It is important that the investigator be experienced in catheter placement and data interpretation to avoid harm to these critically ill patients ."
],
"offsets": [
[
0,
1123
]
]
}
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IntensiveMedizin.00370469.eng.abstr
|
IntensiveMedizin.00370469.eng.abstr
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{
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"The prognosis of patients with malignant diseases requiring treatment on intensive care units is poor . The hospital mortality for mechanically ventilated patients ranges from 70-90% in patients with solid tumors to 75-90% in patients with hematological malignancy and up to 95% in patients after bone marrow transplantation . The number of patients referred to intensive care units is however increasing , due to improvements in the general treatment of malignant diseases . This results in controversies about the utilization of intensive care treatment in these patients . Since the individual outcome can not be predicted prior to initiation of intensive care therapy a general refusal of intensive care treatment seems not justified . A reevaluation of the patients status after initiation of intensive care treatment based on predefined criteria may however be useful in the decision about continuing intensive care measures . Patients requiring mechanical ventilation after bone marrow transplantation will not survive if prolonged treatment with vasopressors is necessary and/or sustained hepatic and renal failure is present . For these patients a withdrawal of further life support may be considered . Intensive care treatment should be continued in patients not fulfilling these criteria and treatment results are comparable to those in patients without malignant diseases . For other patients with malignant diseases the use of a new score system developed for patients with cancer can be helpful in the clinical decision making ."
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[] |
[] |
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] |
IntensiveMedizin.00370488.eng.abstr
|
IntensiveMedizin.00370488.eng.abstr
|
[
{
"id": "IntensiveMedizin.00370488.eng.abstr-passage-0",
"type": "abstract",
"text": [
"Noninterventional standard treatment measures for acute myocardial infarction in the ICU consist of routine care ( medical examination ; adequate bedding and bed rest ; monitoring ; venous access ; oxygen and nitroglycerin therapy ; analgesia ; heparin ) , measures to reduce infarct size and thereby acute and long term mortality ( acetyl salicylic acid ; thrombolytics ; betablockers ; ACE inhibitors - at least in case of more severe pump failure ) - and - finally - prophylaxis and treatment of infarct complications ( heart failure , pulmonary oedema and cardiogenic shock ; life-threatening bradycardias and tachycardias ; ongoing myocardial ischemia ) , with consecutive reduction of immediate mortality . While calcium antagonists are no longer drugs of choice in patiens with myocardial infarction , intravenous magnesium and glucose-insulin-potassium solutions do not yet represent established treatment procedures in myocardial infarction . In case of right ventricular infarction and cardiogenic shock noninterventional treatment alone fails to reduce the high mortality ; this may only be achieved by additional reopening of the infarct related coronary artery - mostly by coronary angioplasty - yielding a sufficient coronary flow ."
],
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] |
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