59 results on '"B, Lüderitz"'
Search Results
2. [Postoperative arrhythmias].
- Author
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Bauriedel G, Skowasch D, Welz A, and Lüderitz B
- Subjects
- Arrhythmias, Cardiac etiology, Arrhythmias, Cardiac prevention & control, Humans, Incidence, Postoperative Complications etiology, Postoperative Complications prevention & control, Prognosis, Risk Factors, Thromboembolism prevention & control, Arrhythmias, Cardiac epidemiology, Postoperative Complications epidemiology
- Published
- 2005
- Full Text
- View/download PDF
3. [Atrial fibrillation -- interventional therapy with respect to age].
- Author
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Lewalter T and Lüderitz B
- Subjects
- Aged, Aged, 80 and over, Anti-Arrhythmia Agents therapeutic use, Anticoagulants therapeutic use, Atrial Fibrillation physiopathology, Combined Modality Therapy, Defibrillators, Implantable, Electric Countershock, Follow-Up Studies, Heart Atria physiopathology, Humans, Middle Aged, Survival Rate, Treatment Outcome, Atrial Fibrillation surgery, Catheter Ablation
- Abstract
Actual therapy of atrial fibrillation follows either the rate or rhythm control strategy. To stabilize sinus rhythm after cardioversion or in case of paroxysmal atrial fibrillation, medical treatment is currently first line therapy. In patients who develop drug-refractory atrial fibrillation, further invasive treatment modalities like preventive pacing, hybrid therapy or catheter-based ablation techniques including pulmonary vein ablation or linear atrial lesion are available. However, interventional atrial fibrillation therapy should be reserved for the highly symptomatic patient due to its limited efficacy and risk of complication. Due to the higher relevance of the AF substrate in elderly patients, ablation therapy will be of limited use until substrate modification in addition to trigger elimination will reach an established stage as a clinical procedure. Hybrid therapy however, with ablation of the cavotricuspid isthmus is as suitable in elderly patients as in the young or middle-aged.
- Published
- 2005
- Full Text
- View/download PDF
4. [Interventional catheter closure of persistent foramen ovale (PFO) in a patient with paradoxical embolism and Brugada's syndrome].
- Author
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Andrié R, Skowasch D, Schmidt H, Kuntz-Hehner S, Hammerstingl C, Ludwig M, Lüderitz B, and Bauriedel G
- Subjects
- Adult, Angiography, Balloon Occlusion instrumentation, Balloon Occlusion methods, Bundle-Branch Block complications, Bundle-Branch Block diagnosis, Bundle-Branch Block physiopathology, Cardiac Catheterization methods, Defibrillators, Implantable, Echocardiography, Doppler, Color, Echocardiography, Transesophageal, Electrocardiography, Embolism, Paradoxical diagnostic imaging, Heart Aneurysm complications, Heart Aneurysm diagnostic imaging, Heart Septal Defects, Atrial complications, Heart Septal Defects, Atrial diagnostic imaging, Humans, Male, Syndrome, Valsalva Maneuver, Embolism, Paradoxical complications, Heart Aneurysm therapy, Heart Septal Defects, Atrial therapy
- Abstract
History and Admission Findings: A 41-year-man was admitted because of acute bluish-grey skin discoloration in cold sensation in the right hand. His brother had suffered sudden cardiac death, aged 42 years., Investigations: Angiography demonstrated embolic occlusion of the digital artery of the right thumb. Transesophageal echocardiography showed a persistent foramen ovale (PFO) with an aneurysm of the atrial septum (ASA) with marked right-to-left shunt of contrast medium during a Valsalva maneuvre as well as two smaller septal fenestrations. There was no evidence of any other source of embolism. The resting electrocardiogram showed an incomplete right bundle branch block with ST elevations in V (1)-V (3), changes like those described in Brugada's syndrome., Treatment and Course: Paradoxical embolism having been demonstrated, the PFO with ASA were closed with a percutaneously introduced Helex septum occluder. Later an implantable cardioverter-defibrillator (ICD) was introduced., Conclusions: A PFO, particularly if associated with an atrial aneurysm, is an important site of paradoxical embolism. In symptomatic patients percutaneous transcatheter septal occlusion should be considered preceding any ICD insertion thought necessary for concurrent Brugada's syndrome.
- Published
- 2004
- Full Text
- View/download PDF
5. [Biventricular thrombi dissolution and antibody development with lepirudin therapy].
- Author
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Skowasch D, Pötzsch B, Kuntz-Hehner S, Gampert T, Rox J, Omran H, Bauriedel G, and Lüderitz B
- Subjects
- Cardiomyopathy, Dilated complications, Cardiomyopathy, Dilated diagnostic imaging, Cardiomyopathy, Dilated drug therapy, Cardiomyopathy, Dilated immunology, Dose-Response Relationship, Drug, Echocardiography, Fatal Outcome, Fibrinolytic Agents adverse effects, Fibrinolytic Agents immunology, Heart Failure complications, Heart Failure diagnostic imaging, Heart Failure drug therapy, Heart Failure immunology, Hematuria chemically induced, Hematuria immunology, Hemoptysis chemically induced, Hemoptysis immunology, Hirudins adverse effects, Hirudins immunology, Humans, Male, Middle Aged, Prothrombin Time, Purpura chemically induced, Purpura immunology, Recombinant Proteins adverse effects, Recombinant Proteins immunology, Subarachnoid Hemorrhage chemically induced, Subarachnoid Hemorrhage immunology, Thrombosis diagnostic imaging, Thrombosis immunology, Antibody Formation immunology, Fibrinolytic Agents administration & dosage, Heart Ventricles diagnostic imaging, Heart Ventricles immunology, Hirudins administration & dosage, Hirudins analogs & derivatives, Recombinant Proteins administration & dosage, Thrombosis drug therapy
- Abstract
History and Admission Findings: A 50-year-old patient presented with clinical symptoms of heart failure with orthopnoe and edema (NYHA IV)., Investigations: Echocardiography revealed a dilated left ventricle with severely reduced left ventricular function and biventricular floating thrombi, due to dilatative cardiomyopathy., Treatment and Course: With a heart failure medication clinical symptoms reduced and body weight decreased > 10 kg in 3 weeks. Due to the high-risk constellation, anticoagulation was performed with lepirudin and the biventricular thrombi were dissolved within 17 days. At this point in time, the patient suffered from petechial bleedings, hemoptysis and gross hematuria. Despite breaking anticoagulation and substitution of PPSB with not measurable fibrinogen, subarachnoid hemorrhage occurred leading to exitus letalis., Conclusion: Lepirudin is a highly effective anticoagulant, that can induce severe hemorrhagic side effects in individual cases. The present case report demonstrates an immunological reaction as a rare cause with activation of prothrombin and formation of fibrin.
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- 2003
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6. [Cardiac resynchronization therapy by biventricular pacing. How many patients with left ventricular dysfunction are eligible?].
- Author
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Yang A, Wolpert C, Schimpf R, Schulz T, Krause U, Jung W, Herwig S, Jeong KM, Omran H, Lewalter T, and Lüderitz B
- Subjects
- Aged, Defibrillators, Implantable, Echocardiography, Electrocardiography, Female, Humans, Male, Middle Aged, Stroke Volume, Ventricular Dysfunction, Left diagnosis, Bundle-Branch Block therapy, Cardiac Pacing, Artificial, Heart Failure therapy, Pacemaker, Artificial, Ventricular Dysfunction, Left therapy
- Abstract
Background and Objective: Cardiac resynchronization therapy by multisite biventricular pacing presents an additive therapeutic option in the treatment of severe congestive heart failure. The objective of the study was to evaluate how many patients with left ventricular dysfunction may potentially benefit from this therapy., Methods: A total of 975 patients were screened for the prevalence of left ventricular dysfunction. Patients with a left ventricular ejection fraction (LVEF) <45 % were included into the investigation. Potential benefit of biventricular pacing was presumed in the presence of: LVEF < 35 %, severe heart failure (NHYA class III or IV), intrinsic left bundle branch block pattern with QRS interval > 150 ms and the absence of atrial fibrillation in the last 3 months before study inclusion., Results: In 203 patients (168 male, 35 female, mean age: 64 +/- 11) an LVEF <45 % was found. A total of 12 of these patients (6 %) or 12 of 113 patients (11 %) with an LVEF <35 % were identified as appropiate candidates for biventricular resynchronization therapy., Conclusions: Cardiac biventricular pacing currently serves as a therapeutic option for a relatively small subgroup of patients with left ventricular dysfunction. Focusing on estimations that the incidence of heart failure in Germany amounts to more than 100.000 cases per year our results suggest that after all more than 6.000 patients per year may potentially benefit from electric resynchronization therapy. This number may increase substantially if prospective studies can prove that patients with heart failure and atrial fibrillation or left ventricular conduction delay due to univentricular pacing also benefit from cardiac resynchronization therapy.
- Published
- 2002
- Full Text
- View/download PDF
7. [Association between progression of untreated coronary lesions and in-stent restenosis].
- Author
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Bauriedel G, Skowasch D, Vaerst J, Jabs A, Andrié R, and Lüderitz B
- Subjects
- Adult, Aged, Coronary Restenosis diagnostic imaging, Coronary Stenosis diagnostic imaging, Coronary Stenosis surgery, Disease Progression, Equipment Design, Female, Humans, Male, Middle Aged, Pilot Projects, Research Design, Coronary Angiography, Coronary Restenosis pathology, Coronary Stenosis pathology, Stents
- Abstract
Background and Objectives: Progression of coronary artery disease is only incompletely understood regarding de-novo stenoses as well as in-stent restenoses (ISR) indicative of accelerated atherosclerosis. The objective of the present angiographic study was to prove an association between target lesion ISR and progression of primarily untreated coronary lesions., Patients and Methods: A total of 179 high-grade native coronary stenoses (mean diameter stenosis 68+/-16 %) of 131 patients were treated by stent implantation. Additional 101 lesions remained untreated because of their moderate to intermediate diameter stenoses (>30 %). Quantitative coronary angiographic analysis was performed 6+/-2 months later to evaluate ISR (diameter stenosis > 50 %), coronary progression (>20 % increase in diameter stenosis) and regression (>20 % decrease), respectively. Angiographic, procedural and clinical characteristics were assessed for a possible association with ISR and/or coronary progression and regression, respectively., Results: ISR was seen in 70 of 179 (39 %) stented target lesions. Presence of diabetes mellitus (p = 0.04) and cumulative duration of inflations (p = 0.01) as procedural determinant were predictive for ISR. Significant progression was found in ten of 101 (10 %) primarily untreated lesions. Progression of previously normal segments or regression were not seen. Progression of native plaques was associated with ISR presence in nine cases and with ISR absence in only one case (p = 0.01). Of note, smoking (p = 0.02) turned out to be predictive for plaque progression, whereas medication and procedural/angiographic parameters were not., Conclusions: The findings of the present pilot study demonstrate target lesion ISR associated with progression of other primarily untreated lesions and thereby suggest that both atherosclerosis types share common systemic pathogenetic mechanisms. With presence of ISR, coronary angiography should also include primarily untreated arteries, especially in case of preexisting plaques.
- Published
- 2002
- Full Text
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8. [QT prolongation and torsade de pointes tachycardia during therapy with maprotiline. Differential diagnostic and therapeutic aspects].
- Author
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Lentini S, Rao ML, Schröder R, Lüderitz B, and Bauriedel G
- Subjects
- Aged, Anti-Arrhythmia Agents administration & dosage, Anti-Arrhythmia Agents adverse effects, Anti-Arrhythmia Agents therapeutic use, Coronary Angiography, Diagnosis, Differential, Drug Interactions, Drug Therapy, Combination, Echocardiography, Electric Countershock, Electrocardiography, Female, Humans, Lidocaine administration & dosage, Lidocaine therapeutic use, Long QT Syndrome diagnosis, Long QT Syndrome therapy, Magnesium administration & dosage, Magnesium therapeutic use, Recurrence, Risk Factors, Tachycardia, Ventricular chemically induced, Tachycardia, Ventricular diagnosis, Tachycardia, Ventricular therapy, Torsades de Pointes diagnosis, Torsades de Pointes therapy, Antidepressive Agents, Second-Generation adverse effects, Long QT Syndrome chemically induced, Maprotiline adverse effects, Torsades de Pointes chemically induced
- Abstract
History and Admission Findings: A 69-year-old somnolent woman developed severe heart failure, aggravated by recurrent episodes of ventricular tachycardia. The patient showed central and peripheral edema. 24 hours earlier, she had suffered cerebral seizures that were successfully terminated by phenytoin. For 13 years, persistent atrial fibrillation had been frequency-controlled with antiarrhythmic drugs (verapamil and glycosides) and treated by oral anticoagulation. In addition, there had been long-term anti-depressant therapy with the tetracyclic agent maprotiline., Investigations: Torsade de pointes tachycardia was documented in the electrocardiograms. In addition, the QT interval was extensively prolonged (QTc = 0.70 sec). Neither electrolyte disturbances nor acute cardiac ischemia were seen. Echocardiography revealed a highly reduced ejection fraction of 25 % and a moderately dilated left ventricle. Angiography showed a collateralized occlusion of the right and plaques of the left coronary artery., Treatment and Course: Repeated torsade de pointes tachycardia resulted in hemodynamic compromise and were terminated by defibrillations. After intravenous magnesium and xylocaine administration as well as with termination of maprotiline and antiarrhythmic co-medication, QT prolongation decreased. In addition, the recurrent torsade de pointes tachycardia stopped. Subsequently, however, there were several bradycardia episodes, QT duration remained long. Accordingly, a VVI pacemaker was implanted. Up to now, the patient is doing well., Conclusions: With antidepressant therapy, a risky constellation including comorbidity and interactions with potentially arrhythmogenic drugs may lead to QT prolongation. Medication that delays conduction or causes bradycardia may generally favour torsade de pointes tachycardia. In case of indispensable multi-drug therapy, regular clinical as well as electrocardiographic monitoring with special emphasis on QT interval is mandatory.
- Published
- 2001
- Full Text
- View/download PDF
9. [Epstein-Barr virus-associated pericarditis].
- Author
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Lentini S, Klingel K, Skowasch D, Kandolf R, and Bauriedel G
- Subjects
- Aged, Diagnosis, Differential, Dyspnea, Epstein-Barr Virus Infections diagnosis, Female, Herpesvirus 4, Human genetics, Herpesvirus 4, Human growth & development, Herpesvirus 4, Human isolation & purification, Humans, Pericardial Effusion diagnostic imaging, Pericardial Effusion virology, Pericarditis diagnosis, Polymerase Chain Reaction, Ultrasonography, Virus Activation, Epstein-Barr Virus Infections complications, Pericardial Effusion etiology, Pericarditis etiology
- Abstract
History and Admission Findings: A 73 year old woman presented with increasing dyspnoea caused by a large pericardial effusion., Investigations: Transthoracic echocardiography revealed a diastolically 35 mm broad pericardial effusion. Subxiphoidal drainage controlled by ultrasound delivered 350 ml of a haemorrhagic fluid that was submitted to pathology and microbiology examination. This was completed by serological and immunological tests and a specific extensive search for malignant diseases, i. e. computer tomograms of chest and abdomen, mammography, bronchoscopy, gastroscopy and coloscopy. All examinations were negative. However, nested PCR analysis of blood leucocytes and of pericardial effusion revealed the pericardial presence of Epstein-Barr virus (EBV), consistent with a localized pericardial EBV persistence or reactivation., Treatment and Course: Follow-up showed a complete resolution of the pericardial effusion without the necessity of further specific treatment., Conclusions: Although EBV infection is common in the general population, cardiac involvement, in particular in the adult, is infrequent and usually takes an uncomplicated course. The present case report demonstrates a beginning pericardial tamponade due to localized pericardial EBV persistence or reactivation without detectable systemic EBV infection. In addition, the importance of molecular tests for diagnostic accuracy is highlighted.
- Published
- 2001
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10. [Transthoracic echocardiography in endocarditis: a comparison of conventional and harmonic echocardiography].
- Author
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Schimpf R, Omran H, Becher H, Rabahieh R, Tiemann K, Jung W, Preusse CJ, Welz A, and Lüderitz B
- Subjects
- Abscess diagnosis, Adult, Aged, Aortic Valve, Endocarditis surgery, Female, Heart Valve Diseases diagnosis, Humans, Image Enhancement, Male, Middle Aged, Mitral Valve, Prospective Studies, Rupture, Spontaneous diagnosis, Echocardiography methods, Endocarditis diagnosis
- Abstract
Background and Objective: Compared with conventional echocardiography (CEC) harmonic imaging (HEC) provides better resolution of the endocardial line and valvular apparatus. This prospective study was undertaken to compare the value of harmonic and conventional transthoracic echocardiography in endocarditis and compare them with standard transoesophageal echocardiography (TOE) and operative findings., Patients and Method: Conventional and harmonic echocardiographic imaging was compared in 30 patients (aged 58 +/- 17 years; 19 males and 11 females) with endocarditis clinically judged to require surgical intervention. The results of both methods were then compared with those of standard TOE and the intraoperative findings., Results: Intraoperatively 15 floating structures, 9 abscesses and 5 perforations were demonstrated. Transoesophageal echocardiography was better than the standard method in diagnosing floating structures and detecting abscesses (15 vs. 10 vegetations, p < 0.05; 7 vs. 5 abscesses, p = 0.05). TOE was better than either method in the diagnosis of abscess., Conclusion: Harmonic transthoracic echocardiography is better than the conventional mode in diagnosing complications of endocarditis.
- Published
- 2000
- Full Text
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11. [Treatment for arrhythmia today--is there an optimal method?].
- Author
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Lüderitz B
- Subjects
- Humans, Arrhythmias, Cardiac therapy
- Published
- 2000
12. [Paroxysmal atrial fibrillation].
- Author
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Lewalter T and Lüderitz B
- Subjects
- Amiodarone therapeutic use, Anti-Arrhythmia Agents therapeutic use, Atrial Fibrillation drug therapy, Atrial Fibrillation mortality, Catheter Ablation, Electric Countershock, Female, Humans, Middle Aged, Monitoring, Physiologic, Pacemaker, Artificial, Prognosis, Quinidine therapeutic use, Recurrence, Risk Factors, Sotalol therapeutic use, Thromboembolism prevention & control, Vasodilator Agents therapeutic use, Atrial Fibrillation therapy
- Published
- 2000
13. [Cardiac pacemaker therapy for optimizing brain circulation. A possible prevention for cerebrovascular diseases?].
- Author
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Hagendorff A, Dettmers C, Jung W, Hümmelgen M, Kölsch C, Hartmann A, Lüderitz B, and Pfeiffer D
- Subjects
- Aged, Anti-Arrhythmia Agents therapeutic use, Atrial Fibrillation drug therapy, Atrial Fibrillation physiopathology, Cardiac Output, Cognition Disorders prevention & control, Dizziness prevention & control, Echocardiography, Doppler, Fatigue prevention & control, Heart Rate, Humans, Male, Memory Disorders prevention & control, Regional Blood Flow, Syncope prevention & control, Thermodilution, Brain blood supply, Cardiac Pacing, Artificial, Cardiovascular Diseases prevention & control, Cerebrovascular Circulation physiology, Pacemaker, Artificial
- Abstract
History and Clinical Findings: A 78-year-old patient experienced dizziness, impairment of mnemic and cognitive function, chronic fatigue and recurrent syncope., Investigations: Hypertensive heart disease, reduced left ventricular function, and ventricular ectopia classification Lown IVb was documented. Computed tomography showed minimal brain atrophia. Stenoses of the brain supplying arteries and of other intracranial diseases were excluded. A distinct correlation between cardiac output and cerebral blood flow in correspondence to changes of heart rate were found (cardiac output 4.2 l/min during sinus rhythm, 7.4 l/min during temporary atrial pacing--AAI-Mode with a pacing rate of 90/min; 4.8 l/min--AAI-Mode with a pacing rate of 120/min; cerebral blood flow: 70, 74 and 62 ml/100 g per minute, respectively). Thus, impairment of cerebral blood flow autoregulation can be assumed., Treatment and Course: After implantation of a permanent pacemaker the patient was without any complaints. The mnemic and cognitive function improved, dizziness and fatigue disappeared. Synopsis did not occur. 14 months later a sudden onset of complaints occurred caused by atrial fibrillation (heart rate 120/min). Cardiac output and cerebral blood flow were now 4.0 l/min and 35 ml/100 g per minute. After antiarrhythmic drug therapy and restoration of sinus rhythm cardiac output and cerebral blood flow increased and the complaints disappeared again., Conclusion: In patients with impaired capacity of cerebral autoregulation a reduced cardiac function and output can induce a reduction of cerebral blood flow. Thus, impairment of mnemic and cognitive function as well as other unspecific neurological deficits can be caused. In these cases pacemaker therapy has to be discussed as an effective therapeutical concept.
- Published
- 2000
- Full Text
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14. [Ventricular septal defect following cardiac trauma: closure with the Amplatzer Septal Occluder]
- Author
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Bauriedel G, Redel DA, Welz A, Eckert HG, Omran H, and Lüderitz B
- Abstract
Ventricular septal defect following cardiac trauma: percutaneous closure with the Amplatzer septal occluder. HISTORY AND CLINICAL FINDINGS: A 36-year old roofer fell 8 m and suffered a severe polytrauma. A complicating pericardial tamponade was relieved as an emergency and myocardial fissure of the left ventricle about 1 cm in length sutured. 2 weeks later, a severe mitral insufficiency due to rupture of the papillary muscle occurred, that was cared by the implantation of a bioprosthesis. 6 weeks later dyspnoea and restricted physical capability were clinically impressive. INVESTIGATIONS AND DIAGNOSIS: Echocardiography demonstrated a posttraumatic muscular ventricular septal defect. Doppler echocardiography and heart catheterization showed a ventricular septal defect still restrictive with a left-to-right shunt (pulmonary-to-systemic flow ratio Qp/Qs 1.8:1). Under exercise, there was a significant increase in mean pulmonary arterial pressure from 27 to 60 mmHg. TREATMENT AND COURSE: The patient who had already been operated twice before was treated by the percutaneous occlusion of the ventricular septal defect from arterio- to venofemoral, a guide catheter was inserted transseptally into the left ventricle. An Amplatzer Septal Occluder, a self-expandable, self-centering wire-mesh double disc with a connecting central stent part, was loaded and then implanted in the ventricular septal defect. The intervention was controlled by fluoroscopy and echocardiography. Post intervention, only a trivial residual shunt was seen. The pumping efficacy of the left ventricle increased, in particular of the septal and apical segments. Clinically, the patient was markedly more load-bearing, the exercise-induced dyspnoea reduced. CONCLUSIONS: Following a cardiac trauma, various complications may occur that can manifest themselves clinically at two or more times. A posttraumatic ventricular septal defect of a patient already operated was successfully occluded by an Amplatzer Septal Occluder. Alongside established surgical methods, the non-operative implantation of new occlusion systems could mean an effective treatment option for muscular ventricular septal defects.
- Published
- 2000
- Full Text
- View/download PDF
15. [Penetrating atherosclerotic ulcer of the thoracic aorta descendens]
- Author
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Lickfett L, Sommer T, Rabahieh R, Bauriedel G, Welz A, and Lüderitz B
- Abstract
Penetrating atherosclerotic ulcer of the thoracic aorta descendens. HISTORY AND CLINICAL FINDINGS: A 75-year-old man with a history of generalised atherosclerosis was admitted to hospital for invasive assessment of progredient typical angina pectoris. Apart from diminished peripheral pulses, physical examination was normal. INVESTIGATIONS: Coronary angiography revealed a three vessel coronary artery disease. The chest X-ray showed elongation and dilatation of the distal aortic arch and the proximal descending aorta thoracalis. Computed tomography and magnetic resonance imaging of the thorax as well as magnetic resonance angiography of the thoracic aorta, demonstrated a penetrating atherosclerotic ulcer of the descending aorta thoracalis, with extensive intramural hematoma. TREATMENT AND COURSE: After percutaneous ballon-dilatation of the right coronary artery and the circumflex artery, the patient was asymptomatic. Considering all aspects of the patients condition, medical treatment of the penetrating atherosclerotic ulcer was decided for the patient. The findings of the thoracic computed tomography after 6 months were unchanged. CONCLUSION: The penetrating atherosclerotic ulcer of the thoracic aorta is a less known clinical entity. Our case report demonstrates that even extensive forms can be clinical asymptomatic and discovered by routine radiologic examinations.
- Published
- 2000
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16. [Persistence of Chlamydia pneumoniae in coronary plaque tissue. A contribution to infection and immune hypothesis in unstable angina pectoris].
- Author
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Bauriedel G, Andrié R, Likungu JA, Welz A, Braun P, Welsch U, and Lüderitz B
- Subjects
- Adult, Aged, Angina, Unstable immunology, Angina, Unstable pathology, Antibodies, Bacterial analysis, Chaperonin 60 immunology, Chlamydia Infections immunology, Chlamydia Infections pathology, Coronary Artery Disease immunology, Coronary Artery Disease pathology, Coronary Vessels pathology, Female, Foam Cells immunology, Foam Cells microbiology, Foam Cells pathology, Humans, Immunoenzyme Techniques, Male, Microscopy, Electron, Middle Aged, Myocardial Infarction immunology, Myocardial Infarction microbiology, Myocardial Infarction pathology, Angina, Unstable microbiology, Chlamydia Infections microbiology, Chlamydophila pneumoniae immunology, Coronary Artery Disease microbiology
- Abstract
Background and Objective: There is an increasing number of pointers towards a causative connection between Chlamydia pneumoniae and atherosclerosis. But the pathogenetic mechanism and intimal structures that are involved remain unclear. Starting with the hypothesis of a chronic infection, as demonstrated by the presence of the chlamydial stress (heat-shock) protein 60 (HSP 60), the presence and localization of these bacterial products in coronary atheromas was investigated., Patients and Methods: Coronary atheroma tissue from primary stenoses in 42 patients (36 men, 6 women, mean age 60.2 +/- 7.3 years) was studied immunohistochemically in the course of a retrospective analysis for chlamydial HSP 60. The findings in clinically acute coronary syndrome (Braunwald's classification) present in 27 patients were compared with those in 15 patients with acute angina and evaluated in relation to expression and site of predilection., Results: An immune reaction to chlamydial HSP 60 was demonstrated in 27 of 42 atheromas (64%). Intact, non-atherosclerotic vessels, such as the mammary artery and sphenous vein, showed no such signals. Chlamydial HSP 60 was localized in maximally 23% of all plaque cells, mostly in macrophages/foam cells, more rarely in smooth muscle cells. Chlamydia in foam cells most often revealed ultrastructural patterns that pointed to the persistence of the pathogen. Sites of predilection of chlamydial HSP were predominantly foam cell areas and cell-poor regions, more rarely inflammatory infiltrates and areas of rupture. When comparing both types of lesion, signals for chlamydial HSP 60 were present in 21 of the 27 atheromas (78%) with unstable angina or acute myocardial infarction, but in only 6 of the 15 atheromas (40%) with stable angina. Within the group with the acute coronary syndrome, the prevalence of chronic chlamydial infection was independent of a previous myocardial infarction., Conclusions: Chlamydial HSP 60 can often be demonstrated in primary coronary stenosis of symptomatic patients. It is most frequently found in macrophages/foam cells and is highly prevalent in the acute coronary syndrome. In-situ findings suggest a pathogenetically relevant role of chronic persistent infection of Chlamydia pneumoniae in unstable coronary plaques.
- Published
- 1999
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17. [Chlamydia pneumoniae in coronary plaques: Increased detection with acute coronary syndrome].
- Author
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Bauriedel G, Welsch U, Likungu JA, Welz A, and Lüderitz B
- Subjects
- Aged, Extracellular Matrix microbiology, Extracellular Matrix ultrastructure, Female, Foam Cells microbiology, Foam Cells ultrastructure, Humans, Immunohistochemistry, Macrophages microbiology, Macrophages ultrastructure, Male, Microscopy, Electron, Middle Aged, Retrospective Studies, Angina Pectoris microbiology, Angina, Unstable microbiology, Chlamydophila pneumoniae isolation & purification, Coronary Artery Disease microbiology
- Abstract
Background and Objective: There is seroepidemiologic and experimental evidence for a link between Chlamydia (C.) pneumoniae and arteriosclerosis. However, the clinical importance and the pathogenic pathways implicated remain unclear. In the present study, we sought to evaluate the presence and the location of C. pneumoniae in coronary atheroma, as well as a potential prevalence with unstable versus stable angina., Patients and Methods: Retrospectively, coronary plaque material of primary lesions from 51 consecutive patients (44 men, 7 women, mean age 59.6 +/- 9.4 years) was examined for the presence of C. pneumoniae by use of immuno-histochemistry and transmission electron microscopy. The findings associated with clinically acute coronary syndrome according to Braunwald's classification (n = 31) were compared to those with stable angina (n = 20) and regarded for potential relations to characteristic intimal features., Results: Immunoreaction for C. pneumoniae was found in 32 of 51 (63%) coronary plaques. Signals (% prevalence of specific intimal features) were present with necrotic areas (40%), sparse cellularity (40%), neo-vascularization (29%), thrombi (20%), ruptured plaque areas (19%), and fields rich in foam cells and calcifications (13%). Intimal hyperplasia and inflammatory infiltrates showed no signals. As the central finding in this report, C. pneumoniae immunoreaction was more frequently (P < 0.001) found in 26 of 31 (84%) lesions associated with unstable angina or acute myocardial infarction, compared to 6 of 20 (30%) lesions with stable angina (P < 0.001). Intact vessels devoid of arteriosclerotic disease, such as mammarial arteries and saphenous veins, were without C. pneumoniae signals (negative controls). Ultrastructurally, chlamydial elementary bodies were found in foam cells and phagocytosing macrophages, also in fragmented extracellular matrix adjacent to apoptotic and necrotic intimal cells., Conclusions: Chlamydiae pneumoniae were detected in 32 of 51 (63%) coronary primary lesions of symptomatic patients. Most importantly, there was a highly significant prevalence of lesions associated with acute coronary syndrome. Predilection sites of C. pneumoniae were areas that revealed small healing activity and (or) propensity to plaque rupture. The present in situ findings indicate a pathogenic role of Chlamydiae pneumoniae in human (coronary) plaque rupture.
- Published
- 1999
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18. [Cardiovascular morbidity in patients with obstructive sleep apnea in relation to the severity of respiratory disorder].
- Author
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Schäfer H, Berner S, Ewig S, Hasper E, Tasci S, and Lüderitz B
- Subjects
- Adult, Aged, Body Mass Index, Cardiovascular Diseases diagnosis, Comorbidity, Female, Humans, Male, Middle Aged, Risk Factors, Sleep Apnea Syndromes diagnosis, Ultrasonography, Cardiovascular Diseases epidemiology, Sleep Apnea Syndromes epidemiology
- Abstract
Basic Problem and Objective: Untreated patients with obstructive sleep apnoea (OSA) have an increased risk of death from cardiovascular (cv) disease. This study was undertaken to determine the disease spectrum in patients with sonographically proven OSA (apnoea-hypopnoea index > or = 5), with special reference to cv risk factors and accompanying diseases in relation to the severity of their respiratory abnormalities. The study's aim was to clarify what risk factors and accompanying diseases were associated with different degrees of OSA., Patients and Methods: A systematic recording of cv risk factors and accompanying diseases as well as their association to the severity of nocturnal respiratory disorders was made for 175 patients (165 men, 10 women, mean age 54 +/- 10.2 years) with sonographically proven OSA (mean apnoea-hypopnoea index 37 +/- 24.4)., Results: The body mass index (BMI) was significantly related to the severity of the respiratory disorder (apnoea-hypopnoea index, AHI, P < 0.05, odds ratio [OR]: 1.95; 95% confidence interval [CI]: 1.15-3.31). In a multivariate analysis, nocturnal breathing pause (P < 0.05; OR: 3.8; 95% CI: 1.3-11.1), left ventricular hypertrophy (P < 0.01; OR: 3.9; 95% CI: 1.5-10.3) and diabetes mellitus (P < 0.05; OR: 4.2, 95% CI: 1.2-14.7) were independently associated with a high-grade breathing disorder (AHI > or = 20). The incidence of left ventricular hypertrophy rose with an increasing severity of nocturnal OSA., Conclusion: These data indicate that in patients with high-grade OSA (AHI > or = 20) there is a further grouping together of cardiovascular risk factors, namely increasing body weight, diabetes mellitus, arterial hypertension and left ventricular hypertrophy; they explain the increased mortality rate among these patients from vascular complications.
- Published
- 1998
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19. [Catheter ablation of atrial flutter. A dependable therapeutic procedure].
- Author
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Schumacher B, Jung W, Lewalter T, Wolpert C, and Lüderitz B
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- Atrial Flutter diagnosis, Electrocardiography, Evaluation Studies as Topic, Humans, Atrial Flutter surgery, Catheter Ablation methods
- Published
- 1998
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20. [Acute posterior wall infarct after factor VIII concentrate administration to a patient with severe hemophilia A].
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Lickfett L, Hagendorff A, Jung W, Pizzulli L, Brackmann HH, and Lüderitz B
- Subjects
- Aged, Angioplasty, Balloon, Coronary, Combined Modality Therapy, Coronary Angiography, Echocardiography, Electrocardiography, Factor VIII administration & dosage, Factor VIII therapeutic use, Hemophilia A complications, Humans, Male, Myocardial Infarction diagnosis, Myocardial Infarction therapy, Self Administration, Thrombolytic Therapy, Factor VIII adverse effects, Hemophilia A drug therapy, Myocardial Infarction chemically induced
- Abstract
History and Clinical Finding: A 69-year-old man with severe haemophilia A sustained an acute myocardial infarction (MI) after self-administration of 3000 units factor VIII over 10 min. On admission he had no signs of heart failure., Investigations: The ECG showed an acute posterior wall MI. Creatinekinase rose to a maximum of 321 U/l with a significant MB proportion. The echocardiogram demonstrated hypokinesia of the posterior wall., Treatment and Course: After initial thrombolysis treatment with a total of 100 mg rtPA according to an accelerated scheme coronary angiography, performed because the symptoms persisted, revealed two-vessel disease. A subtotal stenosis of the right coronary artery was balloon-dilated with good primary results. Regular factor VIII substitution was temporarily administered with the aim of initially achieving high normal levels of factor VIII activity., Conclusion: Factor VIII substitution in haemophilia A may promote thrombotic complications. Thrombolytic treatment and balloon angioplasty of acute MI can be successfully performed even in patients with severe haemophilia A.
- Published
- 1998
- Full Text
- View/download PDF
21. [Circadian and weekly distribution of malignant ventricular arrhythmias in patients with coronary heart disease or dilatative cardiomyopathy who have an implanted cardioverter-defibrillator].
- Author
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Wolpert C, Jung W, Spehl S, Schumacher B, Omran H, Schimpf R, and Lüderitz B
- Subjects
- Cardiomyopathy, Dilated physiopathology, Cardiomyopathy, Dilated therapy, Cluster Analysis, Coronary Disease physiopathology, Coronary Disease therapy, Electrocardiography, Humans, Incidence, Prospective Studies, Tachycardia, Ventricular epidemiology, Ventricular Fibrillation epidemiology, Ventricular Fibrillation physiopathology, Cardiomyopathy, Dilated complications, Circadian Rhythm, Coronary Disease complications, Defibrillators, Implantable, Tachycardia, Ventricular physiopathology
- Abstract
Background and Objective: Epidemiological studies have demonstrated a circadian distribution of sudden cardiac death (SD) and acute myocardial infarction (AMI), with a maximum frequency of events during the morning hours. Recently an analysis of computer recordings of implanted cardioverter/defibrillators has confirmed these findings with respect to SD. The majority of these studies concerned patients with coronary heart disease. In a prospective study we evaluated the circadian and weekly distribution of malignant ventricular tachyarrhythmias (VTA) in patients with a nonischaemic cardiac disease, namely dilated cardiomyopathy (CMP), and those with coronary heart disease (CHD)., Patients and Methods: Over a mean period of 25 +/- 9 months computer-stored data and cardiac electrograms recorded from the implanted cardioverter/defibrillators (ICD) were analysed in 28 patients with CHD and 11 with DCMP. The circadian and weekly distribution of VTA was obtained, using customary arrhythmia classification and the stored and timed events., Results: Patients with CHD had a maximal frequency of VTA or ventricular fibrillation (VF) during the morning, with a peak between 9 and 10 o/c, while those with DCMP were at a higher risk of VTA or VF in the later afternoon and early evening. Regarding the frequency of events during the week, a significantly higher incidence of VTA was recorded on Saturdays in those with CHD, but on Mondays and Wednesdays in those with DCMP., Interpretation: The circadian and weekly distribution of VTA differs significantly between patients with CHD and those with DCMP. A possible reason for this difference may be different trigger mechanisms in the two types of cardiac disease, since transient ischaemia is unlikely to be the cause in patients with nonischaemic DCMP.
- Published
- 1998
- Full Text
- View/download PDF
22. [Septic myocardial aneurysm in mitral valve endocarditis. Clinical and pathological-anatomical findings].
- Author
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Omran H, Reichel H, Wirtz P, Jung W, Rabahieh R, Pfeifer U, Pfeiffer D, and Lüderitz B
- Subjects
- Aged, Autopsy, Electrocardiography, Endocarditis, Bacterial pathology, Female, Heart Aneurysm pathology, Humans, Mitral Valve Insufficiency pathology, Myocardium pathology, Sepsis pathology, Endocarditis, Bacterial diagnosis, Heart Aneurysm diagnosis, Mitral Valve Insufficiency diagnosis, Sepsis diagnosis
- Abstract
History and Clinical Findings: A 68-year-old woman was hospitalized because of fever and tiredness for 3 months. Her general condition was clearly impaired. She had a mild fever of 38.5 degrees C and on auscultation a 3/6 systolic murmur, maximal parasternally in the 3rd intercostal space, transmitted to the apex. There were distant râles over both lungs, the neck veins were distended and there was ankle oedema., Investigations: C-reactive protein was raised to 17.3 mg/dl (normal up to 0.9 mg/dl), WBC count 19,300/microliter. beta-haemolysing streptococcus (S. agalactiae) was grown in the blood culture. The ECG showed sinus tachycardia (rate of 98/min) and transthoracic echocardiography demonstrated a small pericardial, enlarged ventricles, marked mitral regurgitation and a large vegetation on the posterior mitral leaflet, as well as a 3 x 4 cm mass in the posterior wall of the ventricle, originating from the posterior mitral valve ring and communicating with the vegetation on the mitral valve. The posterior mitral leaflet was perforated., Treatment and Course: As endocarditis of the mitral valve with a complicated course was suspected-abscess of the posterior mitral valve ring and septic myocardial aneurysm with associated pericarditis and haemodynamically insignificant effusion-she was transferred to the intensive care unit where she died suddenly of circulatory arrest only 30 min after transfer. Autopsy confirmed the echocardiographic findings., Conclusion: Paravalvular abscess in the course of mitral valve endocarditis is rare, but should be looked for at transthoracic echocardiography so that any necessary surgical intervention can be undertaken early.
- Published
- 1997
- Full Text
- View/download PDF
23. [Thrombolytic therapy for myocardial infarction in oral anticoagulation].
- Author
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Pizzulli L and Lüderitz B
- Subjects
- Administration, Oral, Drug Synergism, Humans, Risk, Streptokinase adverse effects, Tissue Plasminogen Activator adverse effects, Anticoagulants administration & dosage, Hemorrhage chemically induced, Myocardial Infarction drug therapy, Streptokinase therapeutic use, Thrombolytic Therapy adverse effects, Tissue Plasminogen Activator therapeutic use
- Published
- 1996
24. [Driving of a motor vehicle after implantation of a cardioverter-defibrillator in malignant heart rhythm disorders. Criteria for the medical assessment of driving fitness in Europe].
- Author
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Lüderitz B and Jung W
- Subjects
- Accidents, Traffic prevention & control, Arrhythmias, Cardiac diagnosis, Europe, Humans, Surveys and Questionnaires, Time Factors, Arrhythmias, Cardiac therapy, Automobile Driving statistics & numerical data, Defibrillators, Implantable statistics & numerical data, Physical Fitness
- Abstract
Aim of Study: To investigate how medical permission to drive in patients with a cardioverter defibrillator is handled in various European countries., Methods: A specially developed questionnaire was sent to all 46 delegates of the pacemaker groups of the European Society of Cardiology. They were asked to provide information on the procedures and criteria used in the various countries regarding a driving ban after cardioverter defibrillator implantation (ICD)., Results: 39 answers (83%) were received from representatives of 24 countries. 22 (56%) of those replying advised their patients not to drive. A permanent driving ban was recommended by 13 (33%), a temporary one of 3-18 (mean 9 +/- 4) months by 26 (67%). Presyncope was named as a criterion for a ban by 15 (38%), syncope by 13 (33%) and multiple defibrillator shocks by two (5%). Contrary to medical advice not to drive about one third of patients resumed driving, half of them after 6 months. 12 months after implantation most of the patients were again driving. Defibrillator discharges occurred in 2 patients, without consequence. One patient had a fatal car accident, unrelated to loss of consciousness or defibrillator shock., Conclusions: 1. ICD discharges are an extremely rare cause of driving accidents. 2. About half of the cardiologists recommended a driving ban for a mean of 9 months after ICD. 3. Despite medical ban about half of the patients resumed driving after 6 months. 4. There are as yet no uniform criteria in Europe for judging fitness to drive.
- Published
- 1996
- Full Text
- View/download PDF
25. [HIV-associated Pneumocystis carinii pneumonia, primary pentamidine inhalation prophylaxis notwithstanding. Are there differences with Pneumocystis carinii pneumonia without prophylaxis?].
- Author
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Ewig S, Rockstroh JK, Schäfer H, Leutner C, Pickenhain A, and Lüderitz B
- Subjects
- Adult, Aerosols, Aged, Female, Humans, Male, Middle Aged, Pneumonia, Pneumocystis diagnosis, Pneumonia, Pneumocystis mortality, Respiratory Therapy, Time Factors, Tomography, X-Ray Computed, Acquired Immunodeficiency Syndrome complications, Antifungal Agents administration & dosage, Pentamidine administration & dosage, Pneumonia, Pneumocystis prevention & control
- Abstract
Objective: To study the effect of pentamidine aerosol inhalation, known to be effective and well tolerated in the primary prevention of HIV-associated Pneumocystis carinii pneumonia (PCP), on the severity, on clinical and radiological findings and prognosis of break-through PCP., Patients and Methods: Data were obtained from the case notes of 17 men (mean age 36 [23-55] years) with HIV-associated PCP, treated between 1989 and 1994, who had received primary prophylaxis with pentamidine aerosol. During the same period 42 patients with HIV-associated PCP but no pentamidine prophylaxis (39 men, three women; mean age 36 [21-67] years) were also treated. Bronchoalveolar lavage of the most affected segment was performed. Diagnostic measures and treatment remained constant during the period of observation., Results: The clinical presentation was the same in the two groups. There was also no difference between them regarding sensitivity to the lavage (94 and 98%). However, infiltration of the upper segments was significantly more common in the prophylaxis group (90 and 43%; P < 0.02). There was no statistically significant difference between the two groups in death rate (13 and 7%) and the long-term prognosis after PCP (survival time 18 and 24 months, respectively)., Conclusion: Primary prophylaxis of PCP had no significant effect other than altering the distribution pattern of the pneumonic infiltrates towards the apical segments.
- Published
- 1996
- Full Text
- View/download PDF
26. [Nodular pulmonary opacities caused by a severe suppurative bronchitis and bronchiectases].
- Author
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Ewig S, Müller-Miny H, Bauer T, and Lüderitz B
- Subjects
- Aged, Amoxicillin administration & dosage, Bronchitis drug therapy, Bronchitis microbiology, Clavulanic Acid, Clavulanic Acids administration & dosage, Diagnosis, Differential, Drug Therapy, Combination therapeutic use, Haemophilus influenzae isolation & purification, Humans, Klebsiella isolation & purification, Lung Neoplasms diagnostic imaging, Male, Suppuration, Tomography, X-Ray Computed, Bronchiectasis diagnostic imaging, Bronchitis diagnostic imaging
- Abstract
History and Clinical Findings: A 67-year-old man with chronic obstructive pulmonary disease (COPD) for many years and a heavy smoker was hospitalized because of increasing dyspnoea and moderately productive cough. His general condition was clearly impaired. He was markedly cyanotic, he had a barrel-shaped chest, and there were wheezing rhonchi throughout the lung. Body temperature was 37.8 degrees C. He had mild ankle oedema. The preliminary diagnosis was exacerbation of the COPD with global respiratory failure., Tests: There was severe hypoxaemia (pO2 48 mm Hg) with hypercapnia (pCO2 46 mm Hg). Vital capacity was reduced to 1.81, one-second forced expiratory volume 0.91. Chest radiograph revealed multiple nodular opacities, such as seen in bronchial carcinoma with metastases. But computed tomography showed fluid-filled bronchi. Bronchoscopy demonstrated large amounts of dirty-white, sticky secretions as high up as the trachea, confirming the preliminary diagnosis. Klebsiella oxytoca and haemophilus influenzae were cultured from the secretions., Treatment and Course: Immediate administration of amoxycillin and clavulanic acid (2.2 g daily) quickly led to clinical improvement. Chest x-ray was normalized after 10 days. But long-term oxygen treatment was instituted because of persisting resting hypoxaemia (pO2 46 mm Hg), after which he was discharged free of dyspnoea., Conclusion: To clarify nodular pulmonary opacities in a chest radiograph computed tomography should be performed before bronchoscopy.
- Published
- 1995
- Full Text
- View/download PDF
27. [Magnesium in atrioventricular conduction disorders and intraventricular block].
- Author
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Lüderitz B
- Subjects
- Contraindications, Humans, Heart Block, Magnesium
- Published
- 1995
28. [Catheter ablation as an emergency treatment in Wolff-Parkinson-White syndrome with signs of acute infarct].
- Author
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Tebbenjohanns J, Schumacher B, Pizzulli L, Lauck G, Pfeiffer D, and Lüderitz B
- Subjects
- Angina Pectoris etiology, Coronary Angiography, Electrocardiography, Humans, Male, Middle Aged, Myocardial Infarction complications, Tachycardia etiology, Treatment Outcome, Catheter Ablation, Myocardial Infarction surgery, Wolff-Parkinson-White Syndrome complications
- Abstract
A 53-year-old man known to have Wolff-Parkinson-White syndrome suffered an acute posterior-wall myocardial infarction. Despite successful thrombolysis treatment with streptokinase he continued to have attacks of supraventricular tachycardia with angina. The ECG showed a short P-R interval and pre-excitation with positive delta waves in leads V1-6, as well as signs of re-infarction. The tachycardias could not be satisfactorily suppressed by drug treatment. Coronary angiography revealed triple vessel disease. During this investigation ventricular extrasystoles occurred which initiated orthodromic supraventricular tachycardia and angina, as well as monophasic S-T elevations in leads II, III and aVF. This provided the indication for immediate high-frequency catheter ablation left laterally at the mitral anulus after a left-lateral accessory conduction pathway had been identified. Three days later the stenoses of the circumflex and anterior interventricular branches were dilated. The patient has been free of symptoms for 3 months and can exercise up to 150 W. The tachycardias have not recurred.
- Published
- 1995
- Full Text
- View/download PDF
29. [Magnesium in myocardial infarct].
- Author
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Lüderitz B
- Subjects
- Captopril administration & dosage, Captopril therapeutic use, Humans, Infusions, Intravenous, Injections, Intravenous, Magnesium administration & dosage, Magnesium Sulfate administration & dosage, Magnesium Sulfate therapeutic use, Myocardial Infarction mortality, Thrombolytic Therapy, Magnesium therapeutic use, Myocardial Infarction drug therapy
- Published
- 1994
30. [Cardiac manifestations in advanced HIV infection].
- Author
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Ewig S, Fehske W, Omran H, Rockstroh JK, and Lüderitz B
- Subjects
- AIDS-Related Complex complications, AIDS-Related Complex diagnostic imaging, AIDS-Related Complex epidemiology, Adult, Chi-Square Distribution, Echocardiography instrumentation, Echocardiography statistics & numerical data, Echocardiography, Doppler instrumentation, Echocardiography, Doppler statistics & numerical data, Female, Germany epidemiology, HIV Infections diagnostic imaging, HIV Infections epidemiology, Heart Diseases diagnostic imaging, Heart Diseases epidemiology, Humans, Incidence, Male, Middle Aged, HIV Infections complications, HIV-1, Heart Diseases etiology
- Abstract
Incidence, type and clinical significance of cardiac involvement in advanced HIV infection was determined in 32 patients (30 men, two women; mean age 34.2 [21-52] years; mean CD4-cell number 52.2 [0-192]/microliters) over a period of 31 months. Any cardiac involvement was assessed diagnostically by one- and two-dimensional and Doppler echocardiography, complemented by other examinations and results of treatment. 14 patients (43.8%) had abnormal cardiac findings, presumably AIDS-associated. This included left ventricular pump dysfunction of various degrees of severity (n = 11), left ventricular dilatation (n = 2), pericardial effusion (n = 11), as well as cor pulmonale in primary pulmonary arterial hypertension (n = 2). In one patient the first manifestation of AIDS was tubercular pericarditis; in two patients there was a likely connection to disseminated pneumocystis infection and toxoplasmosis, respectively. In 11 patients no specific cause was found for the cardiac involvement. Nine of the 14 patients (64%) had symptoms due to the cardiac involvement. These findings indicate that the incidence and clinical significance of cardiac involvement must be taken into account in any treatment concept for AIDS.
- Published
- 1994
- Full Text
- View/download PDF
31. [Lymphocyte subpopulations in bronchoalveolar lavage fluid in AIDS].
- Author
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Hotz P, Loos U, and Lüderitz B
- Subjects
- Acquired Immunodeficiency Syndrome blood, Acquired Immunodeficiency Syndrome complications, Adolescent, Adult, Female, Humans, Leukocyte Count, Lymphocytosis etiology, Lymphopenia blood, Lymphopenia etiology, Male, Middle Aged, Neutrophils, Pneumonia, Pneumocystis complications, Pneumonia, Pneumocystis immunology, T-Lymphocytes, Helper-Inducer, T-Lymphocytes, Regulatory, Acquired Immunodeficiency Syndrome immunology, Bronchoalveolar Lavage Fluid cytology, Lymphocyte Subsets
- Abstract
Lymphocyte subpopulations in peripheral blood and bronchoalveolar lavage fluid (BAL) were examined in 29 patients with AIDS (26 men, three women; median age 32 [16-55] years). Patients in group 1 (n = 12) had no lung disease, in group 2 (n = 11) had Pneumocystis carinii pneumonia, in group 3 (n = 6) had other lung disease. There were 13 men and two women (median age 48 [21-80]) in the control group (bronchoscoped for mild pulmonary symptoms: no abnormal findings in the BAL). Compared with the control group, patients with AIDS had a significant deficiency in helper cells, both in blood (7-23% vs 50%; P < 0.01) as well as in the BAL (7-24% vs 52%; P < 0.001). There was a correlation of the percentage helper cell proportion in peripheral blood and BAL (for both group 1 and 2, rs = 0.75; P < 0.05). The proportion of helper cells in peripheral blood and BAL in AIDS patients was significantly lower in those with than without lung disease (group 1: 23% blood, 24% BAL vs group 2: 9% blood, 7% BAL; group 3: 7% blood, 7% BAL; P < 0.02 blood, P < 0.004 BAL). The percentage proportion of suppressor cells was greater in both blood and BAL in AIDS patients (group 1: blood 47%, BAL 63%; group 2: blood 44%, BAL 76%; group 3: blood 52%, BAL 75%) than in the controls (blood 28%, BAL 33% [P < 0.01], but there was no correlation between peripheral blood and BAL. In addition, the absolute number of suppressor cells in the lavage (30 cells/microliters in group 1 and 3, 65 cells/microliters in group 2) was significantly higher than in the controls (8 cells/microliters).--In AIDS patients there occurs a lymphocytosis in the BAL, while in blood there is a lymphopenia. The concordant decrease in helper cells in blood and BAL is decisive for the severity of any pulmonary infections.
- Published
- 1994
- Full Text
- View/download PDF
32. [A temporary cardiac pacemaker before major operations?].
- Author
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Lüderitz B
- Subjects
- Heart Block congenital, Heart Block therapy, Humans, Pacemaker, Artificial, Preoperative Care
- Published
- 1993
33. [Radiofrequency ablation of accessory pathways in pre-excitation syndrome].
- Author
-
Pfeiffer D, Tebbenjohanns J, Jung W, Manz M, and Lüderitz B
- Subjects
- Adolescent, Adult, Cardiac Tamponade etiology, Catheter Ablation adverse effects, Female, Heart Conduction System surgery, Heart Ventricles injuries, Humans, Male, Middle Aged, Pneumothorax etiology, Time Factors, Catheter Ablation methods, Pre-Excitation Syndromes surgery, Wolff-Parkinson-White Syndrome surgery
- Abstract
Various parameters relating to the radio-frequency ablation of accessory pathways were studied in 53 patients (27 males, 26 females: mean age 38.5 [14-64] years) with a history of paroxysmal tachycardia (over 1 month to 50 years), shown to be caused by an accessory pathway (Wolff-Parkinson-White syndrome). In all patients the following values were obtained: (1) number of procedures necessary to achieve permanent blockage of the accessory pathway (1-4); (2) duration of each procedure (45-420 min); (3) duration of fluoroscopy (5-102 min); (4) number of necessary radio-frequency applications (1-48); and (5) cumulative energy per procedure. To ablate left-lateral pathways (n = 10) required fewer procedures, shorter duration per procedure, shorter fluoroscopy time, fewer current applications and less total energy than coagulation of right-sided pathways (n = 10). Those various parameters were greatest for ablation of septal and para-septal pathways (n = 9). Pathways which conducted only retrogradely (n = 15) were more difficult to ablate than those with anterograde conduction (n = 38). There were two complications. In one case a tension pneumothorax occurred after faulty puncture of the subclavian vein; in the other, the left ventricle was perforated causing an acute tamponade which required pericardiocentesis with subsequent suture closure of the perforation. It is concluded that, in principle, all accessory pathways, regardless of their conduction potential and site, can be ablated by a radio-frequency current.
- Published
- 1993
- Full Text
- View/download PDF
34. [The quality of life after the implantation of a cardioverter/defibrillator in malignant arrhythmias].
- Author
-
Lüderitz B, Jung W, Deister A, Marneros A, and Manz M
- Subjects
- Adult, Aged, Anxiety epidemiology, Arrhythmias, Cardiac epidemiology, Arrhythmias, Cardiac psychology, Female, Humans, Male, Middle Aged, Patient Acceptance of Health Care statistics & numerical data, Recurrence, Retrospective Studies, Social Adjustment, Surveys and Questionnaires, Arrhythmias, Cardiac therapy, Defibrillators, Implantable statistics & numerical data, Quality of Life
- Abstract
Quality of life after implantation of an automatic implantable cardioverter/defibrillator (ICD) was assessed by questionnaire in 43 patients (38 males, 5 females; mean age 57 +/- 16 years) with treatment-resistant symptomatic ventricular arrhythmias. 37 of the 43 patients felt better after ICD implantation. 23 were always conscious of having an ICD, but 18 had got used to it in less than 2 months. 15 patients reported being afraid of an ICD shock, while eight noted physical discomfort caused by the ICD. Limitations concerning their professional, recreational and social activities were reported by six patients. 41 of the 43 patients confirmed that the ICD had been helpful, enabling 23 to return to an active life. 42 would recommend implantation to others if indicated. These data demonstrate that there is a remarkably high degree of acceptance of the ICD. Survival rate after implantation is thus not the only criterion of success. All aspects of the quality of life should be taken into consideration before implantation is decided upon.
- Published
- 1993
- Full Text
- View/download PDF
35. [Scintigraphy with 123I-labelled fatty acids in coronary heart disease].
- Author
-
Kropp J, Köhler U, Likungu J, Reichmann K, Lüderitz B, and Biersack HJ
- Subjects
- Adult, Aged, Coronary Angiography, Coronary Disease metabolism, Coronary Vessels metabolism, Evaluation Studies as Topic, False Positive Reactions, Female, Humans, Male, Middle Aged, Myocardium metabolism, Tomography, Emission-Computed, Single-Photon methods, Coronary Disease diagnostic imaging, Coronary Vessels diagnostic imaging, Heart diagnostic imaging, Iodine Radioisotopes pharmacokinetics, Iodobenzenes pharmacokinetics
- Abstract
Forty-two patients (6 women, 36 men; mean age 55 [39-69] years), with one-, two- or three-vessel disease on coronary angiography, were studied using single-photon emission computer tomography with 15-p-123I-iodophenyl-pentadecanoic acid (IPPA), in order to evaluate this new method of demonstrating abnormalities of myocardial perfusion. The reference range for fatty acid turnover was determined in eleven controls (4 women, 7 men; mean age 41 [20-51] years) with no coronary stenosis. 185 MBq (5 mCi) of IPPA was administered intravenously during submaximal stress on a bicycle ergometer. Comparison between different regions of the tomograms revealed changes in fatty acid utilization typical of ischaemia. The sensitivity, specificity and predictive value of a positive result compared with coronary angiography were 95%, 89% and 93%, respectively, for the area supplied by the anterior interventricular artery, 92%, 91% and 93% for the circumflex branch and 89%, 91% and 90% for the right coronary artery. In 25 out of 31 patients (81%) with myocardial infarction, IPPA scintigraphy infarct localization agreed with the clinical findings. In two cases with unremarkable scintigrams left ventriculography showed hypokinesia, while in four cases neither method demonstrated any abnormality. There was one false-positive scintigram. IPPA scintigraphy has greater sensitivity and specificity than conventional nuclear medicine techniques in the demonstration of coronary heart disease.
- Published
- 1991
- Full Text
- View/download PDF
36. [Treatment of heart rhythm disorders].
- Author
-
Lüderitz B
- Subjects
- Arrhythmias, Cardiac drug therapy, Heart physiopathology, Humans, Amiodarone therapeutic use, Anti-Arrhythmia Agents therapeutic use, Arrhythmias, Cardiac therapy
- Published
- 1990
37. [Treatment of heart rhythm disorders with magnesium].
- Author
-
Manz M, Mletzko R, Jung W, and Lüderitz B
- Subjects
- Cardiac Complexes, Premature drug therapy, Electrophysiology, Humans, Myocardial Infarction drug therapy, Tachycardia drug therapy, Tachycardia, Supraventricular drug therapy, Arrhythmias, Cardiac drug therapy, Magnesium therapeutic use
- Published
- 1990
- Full Text
- View/download PDF
38. [Functional disorders of chamber demand (VVI) and sequential AV (DDD) pacemakers caused by muscle potentials].
- Author
-
Gerckens U, Nitsch J, and Lüderitz B
- Subjects
- Action Potentials, Adult, Amplifiers, Electronic, Cardiac Catheterization, Electrocardiography, Female, Heart Block therapy, Humans, Male, Middle Aged, Syncope etiology, Equipment Failure, Muscles physiology, Pacemaker, Artificial standards
- Abstract
Muscle potentials as a cause of pacemaker malfunction are often unrecognized, because control examinations are usually performed without physical exercise. Two observations are cited to illustrate how malfunctioning of different modes of stimulation can be caused by interference from muscle potentials. In addition to the known suppression of impulse production, fixed-rate stimulation may occur. These observations indicate that pacemaker function should be tested also during physical activity. Any malfunction can almost always be stopped by re-programming amplifier sensitivity.
- Published
- 1985
- Full Text
- View/download PDF
39. [Supraventricular tachycardia: the results of bundle of His ablation].
- Author
-
Manz M, Steinbeck G, Gerckens U, and Lüderitz B
- Subjects
- Adolescent, Adult, Cardiac Catheterization, Child, Echocardiography, Electric Countershock instrumentation, Electrocardiography, Electrodes, Female, Heart Rate, Humans, Male, Middle Aged, Tachycardia physiopathology, Bundle of His physiopathology, Electric Countershock methods, Heart Conduction System physiopathology, Pacemaker, Artificial, Tachycardia therapy
- Abstract
Transvenous electrical ablation of AV conduction was performed in 15 patients with drug-resistant supraventricular tachycardia. Eight patients had paroxysmal AV nodal reentry tachycardia, one had permanent junctional reentry tachycardia, five had recurrent atrial flutter and one paroxysmal atrial tachycardia. The intracardiac ablation was done with 150-350 J, on average twice per patient. Permanent 3 degrees AV block was achieved in ten patients, in none of whom there was a recurrence of the tachycardia. In four patients with re-established AV conduction the clinical symptoms had nonetheless improved; despite repeated use of His-bundle ablation, permanent junctional reentry tachycardia could not be controlled satisfactorily and required surgical section of the accessory pathway. Apart from septic fever in one patient there were no serious complications. Implantation of a pacemaker, however, was required in all those patients in whom a permanent 3 degrees AV block had been produced. For this reason alone, His-bundle ablation should only be used in drug-refractory supraventricular tachycardias. But in these this method presents an important advance in treatment.
- Published
- 1985
- Full Text
- View/download PDF
40. [Does thyrotoxic cardiomyopathy exist?].
- Author
-
Lüderitz B
- Subjects
- Arrhythmias, Cardiac etiology, Electrocardiography, Hemodynamics, Humans, Hyperthyroidism physiopathology, Cardiomyopathies etiology, Hyperthyroidism complications
- Published
- 1984
- Full Text
- View/download PDF
41. [Inhibition of the heparin effect by nitroglycerin].
- Author
-
Pizzulli L, Nitsch J, and Lüderitz B
- Subjects
- Adult, Aged, Angina Pectoris blood, Angina Pectoris drug therapy, Angina, Unstable blood, Angina, Unstable drug therapy, Drug Interactions, Drug Therapy, Combination, Female, Glucose, Heparin blood, Humans, Isotonic Solutions, Male, Middle Aged, Partial Thromboplastin Time, Propylene Glycol, Propylene Glycols, Solutions, Heparin therapeutic use, Heparin Antagonists, Nitroglycerin therapeutic use
- Abstract
The interaction of intravenous (i.v.) nitroglycerin (glyceryl trinitrate) on the anticoagulant effect of heparin was studied in 27 patients. The heparin dose was adjusted (800-1400 IU/h) to achieve partial thromboplastin time (PTT) of more than 100 s (130 +/- 28 s). While the heparin infusion was continued at the same dosage, the patients received 2-5 mg/h nitroglycerin i.v. (Perlinganit without propylene glycol [15 patients] or Gilustenon with propylene glycol [12 patients]). During combined heparin and nitroglycerin (NG) administration PTT decreased significantly (60 +/- 23 s; P less than 0.01). After withdrawal of NG, PTT increased to the initial levels (126 +/- 30 s). The drug interaction was seen in both groups--with or without propylene glycol. In nine of the 27 patients plasma heparin levels were measured; they remained unchanged during NG administration. The results indicate that i.v. NG induces heparin resistance. After NG is withdrawn, a rebound increase in PTT may occur. Adequate monitoring of PTT and heparin dosage adjustment are thus required during combined heparin and NG administration.
- Published
- 1988
- Full Text
- View/download PDF
42. [Acceleration of amiodarone elimination by cholestyramine].
- Author
-
Nitsch J and Lüderitz B
- Subjects
- Adult, Aged, Amiodarone administration & dosage, Amiodarone adverse effects, Amiodarone blood, Cholestyramine Resin administration & dosage, Female, Half-Life, Humans, Male, Middle Aged, Time Factors, Amiodarone metabolism, Benzofurans metabolism, Cholestyramine Resin pharmacology
- Abstract
In eleven patients serum levels of amiodarone and its desethyl metabolite were determined after a single dose of 400 mg amiodarone given with and without subsequent administration of colestyramine. In addition, the elimination half-life was measured in three patients after discontinuation of long-term amiodarone therapy. Mean serum levels of amiodarone at 7 1/2 hours after dosing (n = 11) were 0.42 +/- 0.11 micrograms/ml without colestyramine and 0.21 +/- 0.14 micrograms/ml with colestyramine (P less than 0.01). Elimination half-life after discontinuing long-term amiodarone therapy (n = 3) was 23 1/2, 29 and 32 days, respectively (half-life in eight controls: 35-58 days). The results indicate that colestyramine significantly reduces the enterohepatic circulation of amiodarone. Therefore, colestyramine should be capable of accelerating the regression of dose-dependent side-effects of amiodarone by enhancing its elimination.
- Published
- 1986
- Full Text
- View/download PDF
43. [Rate-responsive cardiac pacemaker. State of development and clinical value].
- Author
-
Gerckens U and Lüderitz B
- Subjects
- Arrhythmia, Sinus therapy, Bradycardia therapy, Heart Block therapy, Humans, Arrhythmias, Cardiac therapy, Pacemaker, Artificial standards
- Published
- 1987
- Full Text
- View/download PDF
44. [Hemodynamic aspects in therapy with anti-arrhythmia agents].
- Author
-
Lüderitz B
- Subjects
- Anti-Arrhythmia Agents adverse effects, Heart Rate drug effects, Humans, Anti-Arrhythmia Agents therapeutic use, Hemodynamics drug effects
- Published
- 1989
- Full Text
- View/download PDF
45. [Repeated criminal poisoning with nitrostigmine (E 605 forte) (author's transl)].
- Author
-
Lüderitz B, Boelke G, Gaaz JW, Schmidt H, and Riecker G
- Subjects
- Acetylcholinesterase blood, Cholinesterase Inhibitors poisoning, Constriction, Diagnosis, Differential, Electrocardiography, Erythrocytes enzymology, Eye Manifestations, Fatigue chemically induced, Humans, Hypertension chemically induced, Male, Muscle Tonus, Poisoning diagnosis, Poisoning enzymology, Pulmonary Edema chemically induced, Pupil, Salivation, Sweating, Tachycardia chemically induced, Crime, Parathion poisoning
- Published
- 1974
- Full Text
- View/download PDF
46. [A scheme for the diagnosis of primary hyperparathyroidism (author's transl)].
- Author
-
Hesch RD, McIntosh C, Lüderitz B, Hauswaldt C, and Schuster R
- Subjects
- Acid Phosphatase blood, Adult, Alkaline Phosphatase blood, Biopsy, Calcium blood, Calcium urine, Catheterization, Cyclic AMP urine, Femur diagnostic imaging, Hand diagnostic imaging, Humans, Lumbar Vertebrae diagnostic imaging, Male, Methods, Parathyroid Hormone blood, Pelvic Bones diagnostic imaging, Pelvic Bones pathology, Phosphates blood, Radiography, Skull diagnostic imaging, Hyperparathyroidism diagnosis
- Published
- 1974
- Full Text
- View/download PDF
47. [Elevated plasma flecainide concentrations in heart failure].
- Author
-
Nitsch J, Neyses L, Köhler U, and Lüderitz B
- Subjects
- Adult, Aged, Female, Flecainide administration & dosage, Heart Failure diagnosis, Heart Failure drug therapy, Humans, Male, Middle Aged, Stroke Volume, Time Factors, Flecainide blood, Heart Failure blood
- Abstract
In 42 patients with heart failure who were on long-term treatment with flecainide (2 X 100 mg daily by mouth) plasma concentration of flecainide was measured before the morning dose and compared with the clinical grade of heart failure or left ventricular ejection fraction (in the levo-angiogram). Mean plasma flecainide concentration was 415 +/- 244 ng/ml (110-1035 ng/ml), mean ejection fraction 55 +/- 17.7% (24-84%) (r = -0.60). In seven patients with plasma concentrations over 700 ng/ml (870 +/- 150 ng/ml) in clinical grade III or IV, ejection fractions were 24, 25, 25, 30, 33, 37 and 44%, respectively. In two patients (ejection fraction of 24 and 25%, respectively) the morning plasma concentration was around 1000 ng/ml. The results point to possible high plasma flecainide concentrations--at times in the toxic range--in patients who are in heart failure. In patients with marked reduction in left ventricular pumping function who are on long-term flecainide treatment, a reduction in dosage or monitoring of plasma flecainide concentration is indicated.
- Published
- 1987
- Full Text
- View/download PDF
48. [Captopril versus digoxin in the treatment of mild to moderately severe heart failure].
- Author
-
Heck I, Müller HM, Esser H, and Lüderitz B
- Subjects
- Blood Pressure drug effects, Captopril adverse effects, Chronic Disease, Clinical Trials as Topic, Digoxin adverse effects, Double-Blind Method, Drug Therapy, Combination, Echocardiography, Female, Heart Failure diagnosis, Heart Failure physiopathology, Humans, Hydrochlorothiazide therapeutic use, Male, Middle Aged, Stroke Volume drug effects, Captopril therapeutic use, Digoxin therapeutic use, Heart Failure drug therapy
- Abstract
In a randomized and double-blind study of 116 patients with chronic heart failure (NYHA classes II or III) the effectiveness of captopril + hydrochlorothiazide (HCT) (group 1) and of digoxin + HCT (group 2) were compared. Treatment was effected for a 12-month period with a combination of 50 mg captopril (twice 25 mg daily, oral) and HCT, or 0.2 mg digoxin (twice 0.1 mg daily, oral) and HCT. In a pretreatment phase over 3-4 weeks the patients of group 1 were given an average HCT dose of 37.7 mg daily, whereas those of group 2 received 34.9 mg per day. At the end of the 12-month treatment period the patients in the captopril/HCT group had improved significantly more--by the criteria of echocardiographic intracardiac diameters, exercise tolerance and NYHA class--than those in the digoxin/HCT group. Change by a mean of one NYHA class had occurred in 61 patients (51.8%) of group 1 and in 47 (40.7%) of group 2 (P les than 0.01). These findings suggest that treatment of patients with mild to moderately severe chronic heart failure in sinus rhythm best be initiated with an angiotensin-converting enzyme inhibitor together with a diuretic rather than a digitalis-diuretic combination.
- Published
- 1989
- Full Text
- View/download PDF
49. [Long-term drug therapy in ventricular cardiac arrhythmias. Is an improvement of the prognosis possible?].
- Author
-
Lüderitz B, Manz M, and Steinbeck G
- Subjects
- Adult, Aged, Amiodarone therapeutic use, Aprindine therapeutic use, Disopyramide therapeutic use, Humans, Long-Term Care, Mexiletine therapeutic use, Middle Aged, Tachycardia drug therapy, Arrhythmias, Cardiac drug therapy
- Abstract
Oral long-term treatment with various antiarrhythmic drugs (aprindine, mexiletine, disopyramide, amiodarone) was assessed in 82 patients with recurrent tachycardias demonstrated in the ECG using programmed ventricular stimulation. It was shown that sudden cardiac death and recurrence of tachycardia were clearly reduced in the group of patients (n = 29) in whom drug treatment prevented ventricular tachycardia following electric stimulation. Amiodarone was demonstrated to be the most effective substance in this respect, notwithstanding some side effects.
- Published
- 1983
- Full Text
- View/download PDF
50. [Pacemaker treatment of tachyarrhythmias by programmed rate-related interval stimulation(author's transl)].
- Author
-
Lüderitz B, Steinbeck G, Guize L, and Zacouto F
- Subjects
- Aged, Atrial Flutter therapy, Cardiac Complexes, Premature therapy, Coronary Disease complications, Electrocardiography, Heart Ventricles, Humans, Male, Middle Aged, Pacemaker, Artificial, Tachycardia complications, Time Factors, Tachycardia therapy
- Abstract
Programmed rate-related interval stimulation proved to be a low-risk method when applied to 74 patients with drug-resistant ventricular tachycardia or runs of ventricular extrasystoles as precursors of tachycardia. Atrial flutter was converted to atrial filbrillation and sinus rhythm by atrial interval-related multiple stimulations. Tachycardias, which could not be terminated by simple or double stimulation, were successfully suppressed by sequential ventricular R-R related multiple stimulations. Rare-related stimulation has proved to be an alternative method of treating tachy-arrhythmias unresponsive to conventional means.
- Published
- 1975
- Full Text
- View/download PDF
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