The Mechanisms Responsible for Lack of Reproducible Induction of Atrioventricular Nodal Reentrant Tachycardia

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/75434/1/j.1540-8167.1996.tb00556.x.pd

Radiofrequency Ablation of Idiopathic Left Anterior Fascicular Tachycardia

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/71580/1/j.1540-8167.1995.tb00389.x.pd

A Quantitative Fluoroscopic Comparison of the Coronary Sinus Ostium in Patients With and Without AV Nodal Reentrant Tachycardia

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/75367/1/j.1540-8167.1995.tb00444.x.pd

927-37 Is Coronary Revascularization Complete Therapy for Secondary Prevention of Ischemic Cardiac Arrest?

Coronary revascularization has been suggested assole therapy for secondary prevention of sudden cardiac arrest associated with ischemia. Among 412 consecutive patients receiving an implantable defibrillator (ICD), 23 (6%) were identified as: sudden cardiac arrest survivors, noninducible with programmed stimulation, unstable angina or ischemia on a functional study, and underwent successful coronary revascularization. In follow-up, 10 (43%) of the 23 patients received ICD shocks (8±8 per patient, range: 1–22) shocks) and 9/10 had syncope/presyncope associated with at least one ICD discharge.Clinical Characteristics:ICD firings (n=10)*No ICD firings (n=13)*Follow-up (months)39±1331±21Age (years)63±763±12Male gender89Mean left ventricular ejection fraction (%)36±1040±14Previous history of a myocardial infarction1010Presence of a left ventricular aneurysm41Q-wave infarction pattern on electrocardiogram75Sudden cardiac arrest presenting with exertion, angina, or CPK elevation88Mean number of vessels with coronary disease2.2±0.823±0.9Mean severity of coronary stenosis (%)87±1888±16Coronary revascularization considered complete710β-blocker therapy55Antiarrhythmic therapy812*p value>0.05No clinical characteristic was statistically different between patients with and without ICD shocks. In conclusion, coronary revascularization alone may be inadequate therapy for survivors of sudden cardiac arrest associated with ischemia who are noninducible with programmed stimulation, and clinical variables cannot predict which patients are likely to experience recurrent malignant ventricular arrhythmias. Therefore, ICD therapy should be considered in these patients

The Economic Impact of Transvenous Defibrillation Lead Systems

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/72437/1/j.1540-8159.1994.tb02379.x.pd

927-37 Is Coronary Revascularization Complete Therapy for Secondary Prevention of Ischemic Cardiac Arrest?

Coronary revascularization has been suggested assole therapy for secondary prevention of sudden cardiac arrest associated with ischemia. Among 412 consecutive patients receiving an implantable defibrillator (ICD), 23 (6%) were identified as: sudden cardiac arrest survivors, noninducible with programmed stimulation, unstable angina or ischemia on a functional study, and underwent successful coronary revascularization. In follow-up, 10 (43%) of the 23 patients received ICD shocks (8±8 per patient, range: 1–22) shocks) and 9/10 had syncope/presyncope associated with at least one ICD discharge.Clinical Characteristics:ICD firings (n=10)*No ICD firings (n=13)*Follow-up (months)39±1331±21Age (years)63±763±12Male gender89Mean left ventricular ejection fraction (%)36±1040±14Previous history of a myocardial infarction1010Presence of a left ventricular aneurysm41Q-wave infarction pattern on electrocardiogram75Sudden cardiac arrest presenting with exertion, angina, or CPK elevation88Mean number of vessels with coronary disease2.2±0.823±0.9Mean severity of coronary stenosis (%)87±1888±16Coronary revascularization considered complete710β-blocker therapy55Antiarrhythmic therapy812*p value>0.05No clinical characteristic was statistically different between patients with and without ICD shocks. In conclusion, coronary revascularization alone may be inadequate therapy for survivors of sudden cardiac arrest associated with ischemia who are noninducible with programmed stimulation, and clinical variables cannot predict which patients are likely to experience recurrent malignant ventricular arrhythmias. Therefore, ICD therapy should be considered in these patients

Patients with an ICD Can Safely Resume Work in Industrial Facilities Following Simple Screening for Electromagnetic Interference

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/74026/1/j.1460-9592.2003.t01-1-00251.x.pd

A Prospective Evaluation of Two Defibrillation Safety Margin Techniques in Patients with Low Defibrillation Energy Requirements

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/75077/1/j.1540-8167.1998.tb00865.x.pd

Incidence, presentation, diagnosis, and management of malfunctioning implantable cardioverter-defibrillator rate-sensing leads

Recognition of tachyarrhythmia by an implantable cardioverter-defibrillator (ICD) requires an intact rate-sensing lead. We retrospectively examined 266 consecutive patients requiring an ICD to characterize the incidence, clinical presentation, diagnosis, and management of a defective rate-sensing lead. To identify clinical parameters that may contribute to lead complications, we also assessed the effects of age, gender, type of rate-sensing lead, manufacturer of the lead, and surgeon. Over a follow-up period of 30 +/- 22 months (mean +/- standard deviation), a defective lead was found in 9 (3.4%) patients, in 9 (1.7%) of 514 leads over a period of 2 to 39 (mean 17 +/- 15) months after implantation. Except for 1 patient, in whom a lead fracture was incidently found during ICD generator replacement, these patients had multiple inappropriate shocks of recent onset. Clinical parameters were not helpful in identifying patients at risk for lead complication. An abnormal beeping signal obtained while the patients performed various maneuvers was helpful in confirming a defect. All of the defective leads were epicardial. These cases were managed by placement of a transvenous endocardial lead.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/31233/1/0000136.pd

Placement of electrode catheters into the coronary sinus during electrophysiology procedures using a femoral vein approach

The femoral vein approach used in this study has 2 limitations. First, it requires the use of a deflectable tip catheter, which typically is $200 to$300 more expensive than a standard electrode catheter. Second, with the femoral vein approach used in the present study, the total number of pacing and recording sites is limited to 3. However, because the coronary sinus catheter can be used for atrial pacing, and because the right atrial electrogram is rarely required for diagnostic purposes, we have found the combination of the coronary sinus, His bundle electrogram, and right ventricular apex positions to be adequate in virtually all patients undergoing an electrophysiologic procedure in whom coronary sinus electrograms are needed for a diagnostic or mapping purpose.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/31439/1/0000357.pd