Pacing and clinical electrophysiology : PACE
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Pacing Clin Electrophysiol · Apr 1993
Efficacy and safety of combination therapy with amiodarone and type I agents for treatment of inducible ventricular tachycardia.
In a prospective study the efficacy of amiodarone in combination with the three Class I drugs mexiletine, flecainide, or encainide was evaluated consecutively in 12 patients with recurrent ventricular tachycardias (VT) by programmed stimulation. None of the tested drug combinations suppressed induction of sustained VT. The combination of amiodarone with Class IC drugs flecainide and encainide prolonged the cycle length of VT significantly, whereas the combination with mexiletine did not have the same degree of slowing on the VT cycle length. ⋯ The only predictor for the occurrence of proarrhythmic events was found in left ventricular ejection fraction. These findings suggest that in patients refractory to amiodarone alone or a combination with mexiletine, the combined treatment of amiodarone with other Class IC drugs prolongs the VT cycle length but does not suppress induction of VT during programmed stimulation. Combination therapy of amiodarone with encainide was associated with a high incidence of proarrhythmic effects.
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Pacing Clin Electrophysiol · Mar 1993
Randomized Controlled Trial Multicenter Study Clinical TrialICD versus drugs in cardiac arrest survivors: preliminary results of the Cardiac Arrest Study Hamburg.
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Pacing Clin Electrophysiol · Nov 1992
Complications of single lead VDD pacing in 35 patients with AV block.
The implantation of a VDD system is comparable to that of a VVI system, but its management is associated with typical complications of dual chamber pacing. In 35 patients with symptomatic AV block and normal sinus node function, two different VDD pacing systems were implanted. Most of the complications described and their mode of resolution were common to VDD and DDD pacing; however, the VDD system eliminated the need for two separate leads. We, therefore, favor single lead VDD pacing in the treatment of complete AV block with normal sinus node function.
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Pacing Clin Electrophysiol · Nov 1992
Survival after a first episode of ventricular tachycardia or fibrillation.
Recent outcome analyses in ventricular tachycardia (VT) and ventricular fibrillation (VF) have included patients undergoing electrophysiological study (EPS) at tertiary care centers. The selection process involved could introduce bias in the reported populations. We analyzed the outcome of 42 consecutive patients (aged 63 +/- 11 years) admitted to a coronary care unit within 48 hours of a first episode of VT/VF not associated with reversible causes. ⋯ Mortality after a first episode of VT/VF is high. Severe congestive heart failure is the most powerful prognostic factor. Studies including successfully referred patients undergoing EPS may not reflect the true natural history of patients with VT/VF.
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Pacing Clin Electrophysiol · May 1992
Case ReportsBidirectional tachycardia induced by herbal aconite poisoning.
This report details the clinical, electrocardiographic, and electropharmacological characteristics of an unusual case of bidirectional tachycardia induced by aconites present in a Chinese herbal decoction consumed by a previously healthy subject. The tachycardia showed marked susceptibility to vagotonic maneuvers, cholinesterase inhibition, and adenosine triphosphate. ⋯ The rootstocks of aconitum plants have been commonly employed in traditional Chinese herbal recipes for "cardiotonic" actions and for relieving "rheumatism." Multiple pitfalls could occur during the processing of these herbs that might have predisposed to aconite poisoning. The need for strict control and surveillance of herbal substances with low margins of safety is highlighted.