Effect of Ventricular Shock Strength on Cardiac Hemodynamics

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/75115/1/j.1540-8167.1998.tb00118.x.pd

Long-Term Evaluation of the Ventricular Defibrillation Energy Requirement

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/74692/1/j.1540-8167.1998.tb00132.x.pd

Prolonged Asystole during Head-Up Tilt Test in a Patient with Malignant Neurocardiogenic Syncope

A 27 year-old man was taken to our emergency room after collapsing during a conference. The patient had a history of syncope twice since age 15. A marked sinus bradycardia and asystole were induced causing the patient to collapse when tested to stand up in the emergency room. Cardioinhibitory type neurocardiogenic syncope was considered to be the cause of the syncope. Therefore the patient was treated with oral disopyramide at a daily dose of 150 mg. Three weeks later, a head-up tilt test was performed for evaluation of drug effectiveness. However, a prolonged asystole for 24 seconds due to sinus arrest without escape beat was induced 7 minutes after starting the tilt at 80 degrees. Although the tilt table was returned to the flat position immediately, it took an additional 30 seconds for complete recovery of the patient's consciousness. Malignant cardioinhibitory type neurocardiogenic syncope with a prolonged asystole such as was found in this patient has rarely been observed. Treatment options should be discussed if the patient refuses pacemaker implantation

Clinical Efficacy of Bepridil for Class I Antiarrhythmic Drug-Induced Atrial Flutter in Patients with Paroxysmal Atrial Fibrillation

Background: Class I antiarrhythmic drugs can promote the organization of atrial fibrillation (AF) and sometimes converts AF into atrial flutter (AFL) concomitant with difficulty of rate control. We studied the usefulness of Bepridil, which exhibits a class III-like effect, for class I drug-induced AFL in patients with paroxysmal AF. Methods: The study population consisted of 17 consecutive patients (15 men, mean age 65 ± 8 years) with AFL converted from paroxysmal AF following oral treatment of class IA or IC antiarrhythmic agents including pilsicainide (n = 8), cibenzoline (n = 5), flecainide (n = 2), aprindine (n = 1), and propafenone with cibenzoline (n = 1). After the occurrence of AFL, class I drug was replaced by bepridil with a dose of 100–200 mg per day in all patients. Results: After the treatment with bepridil, 15 (88%) out of the 17 patients restored sinus rhythm after 1 to 68 days (average of 21 days). In 12 (80%) of the 15 patients, sinus rhythm was maintained for an average of 23.6 months (range of 1 to 62 months) follow-up period. Although torsade de pointes was not recognized, a marked QT prolongation (0.60 sec) was observed in one patient during the administration of bepridil at a daily dose of 200 mg. In this patient, QT interval was normalized (0.45 sec) after reduction of bepridil to 150 mg daily. Conclusion: Bepridil treatment may be safe and effective for class I drug-induced AFL in patients with paroxysmal AF to restore and maintain sinus rhythm as an alternative therapy for catheter ablation. However, the QT interval must be carefully monitored during this medication

Variations in cephalic vein venography for device implantation–Relationship to success rate of lead implantation

Introduction: Lead implantation using the cephalic vein (CV) cutdown technique has been well established, but is not always expected to achieve high success rates. We studied the relationship between preoperative CV venography and the success rate of lead implantation. Methods: Two hundred and twenty one CV venographies were performed in 205 patients (mean age 75 years, 113 males). Leads were inserted via the CV cutdown technique with a guidewire and sheath. Variations in CV venography included usage of the right and left CVs. The success rate of lead implantation was studied. Results: No major kink was observed in 71% of the right CV cases and 43% of the left CV cases. Leads were successfully implanted in over 90% of these patients. A major kink in the CV was found in 15% of the right CV cases and 34% of the left CV cases and successful lead implantation was around 80% in this population. The overall success rate tended to be higher for the right side (83%) than for the left side (71%). Conclusion: Severe kinks or variations in the CV that hinder lead manipulation were less frequent in the right CV. Therefore, a higher success rate of lead implantation by the cutdown technique is expected for the right CV