Clinical experience with the Elema Vario pacemaker.
(17/27)
Early problems after implantation of an endocardial electrode for permanent pacing occur in many patients. Difficulties can be anticipated in many of these patients and their management made much easier by a knowledge of the daily endocardial threshold obtained in patients with an implanted Elema Verio pacing unit by a simple non-invasive technique using a magnet and electrocardiogram. Twenty patients are described in whom permanent pacing with an Elema Vario unit was undertaken. The practical advantages of this unit can be readily seen in the patient who developes exit block or in the patient with obstructive airways disease, in whom frequent coughing or right ventricular hypertrophy may make stable electrode placement difficult. The chief advantage of the Elema Vario pacemaker is the extreme simplicity with which knowledge of the endocardial threshold can be obtained. (+info)
Surdo-cardiac syndrome: incidence among children in schools for the deaf.
(18/27)
This is a report on a survey of 1126 deaf children in three schools for the deaf in the Province of Ontario. One case of the surdo-cardiac syndrome previously reported is included. There were four other children who had a history of syncope but no prolongation of the Q-T interval on the ECG. It is possible that these may represent a variant of the syndrome. Five more children had a prolonged Q-T interval but no fainting spells. (+info)
The surdo-cardiac syndrome and therapeutic observations.
(19/27)
First recognized in 1957, the surdo-cardiac syndrome includes congenital deafness, prolonged QT interval, and a high incidence of syncope and sudden death. Haemodynamic studies in two patients were normal except for an abnormal wave during left ventricular diastole probably related to abnormal left ventricular relaxation. The syncopal attacks are based on cardiac arrhythmias: both ventricular fibrillation and asystole may occur. Abnormal adrenergic stimulation of the heart is probably responsible. Propranolol appears to be effective in preventing the syncopal attacks. Artificial pacemaking provoked ventricular fibrillation in one patient and seems contraindicated. (+info)
Four cases of right-sided bundle-branch block and one case of atrioventricular block in three generations of a family.
(20/27)
Four cases of complete right bundle-branch block and one case of atrioventricular heart block, all occurring within three generations of the same family, are described. The 4 patients with bundle-branch block had no symptoms, whereas the patient with atrioventricular heart block suffered Adams-Stokes attacks from the age of 13 and died at 47 years of age. A 33-year-old man with bundle-branch block had a normal electrocardiogram at the age of 7, suggesting that inherited bundle-branch block does not necessarily manifest itself during the first years of life. (+info)
Myocardial infarction and complete heart block.
(21/27)
The clinical and electrocardiographic records of 20 patients with complete A-V block due to acute myocardial infarction have been analyzed. This study indicated that patients with an inferior wall myocardial infarction had, most commonly, a block above the bifurcation. The block was transitory, the patients had no Stokes-Adams attacks and the outcome was good. None of our patients required artificial pacing. On the other hand, patients with an anteroseptal myocardial infarction suffered from a bilateral bundle branch block (below the bifurcation). They had severe Stokes-Adams attacks and they all required artificial pacing. The destruction of the conducting system was extensive and the outcome was poor. Five out of seven patients treated with artificial pacing recovered the A-V conduction through the left bundle within a few days. However, in spite of this they all died.From this small series clearly defined clinical and electrocardiographic features can be identified in two different groups of cases. (+info)
Conservative treatment of chronic heart block.
(22/27)
A study of 203 patients with chronic heart block treated with oral long-acting isoprenaline showed that 85 (42%) were maintained satisfactorily on the drug for a mean period of 18.2 months. The survival rates at one, two, and three years were 76%, 64%, and 57% respectively. In 115 patients treatment by pacing became necessary to control symptoms, and in these patients the survival rates at one, two and three years were 83%, 72%, and 60%.The two most valuable guides to patients' response to oral isoprenaline are the response to a trial dose of intravenous isoprenaline and the type of dysrhythmia associated with their Adams-Stokes attacks. Patients with heart failure with slow ventricular rates and those with angina of effort do not respond to treatment with sympathomimetic drugs.The majority of patients with chronic heart block are elderly, and in view of the complexity of pacing systems, and the need for skilled supervision of paced patients, oral long-acting isoprenaline remains of value in the longterm management of chronic heart block, provided patients are carefully selected for this form of therapy. (+info)
Three years' experience with implanted pacemakers.
(23/27)
At the University Hospital, Saskatoon, over the last three years, pacemakers have been inserted in 40 patients with complete or incomplete heart block. Fourteen of the patients were females and 26 were males. The average age was 65 years; 12 were over 80 years of age, and the youngest patient was 8 years of age. In none was the heart block due to operation. Thirty-three patients are still alive and well. There have been seven deaths three early and four late. One patient died because of a "runaway" pacemaker, and two as a result of infection persisting around the pacemaker. Twenty-nine Medtronic pacemakers were used and 14 Atricor pacemakers; currently we favour the latter instrument. (+info)
Use of subclavian vein for permanent cardiac pacing.
(24/27)
The subclavian vein has been used to implant permanent pacing catheters in 40 patients with symptomatic heart block. Though the cephalic and external jugular veins are usually preferred for this purpose in Britain, the use of these veins has certain disadvantages. In this study subclavian venepuncture by the infraclavicular approach was performed without diffculty and found to be a safe procedure. Three months after implantation, 7.5 per cent of patients had developed catheter tip dislocation and 87.5 per cent of patients were entirely free of complications. (+info)