The Experts below are selected from a list of 123 Experts worldwide ranked by ideXlab platform
A. J. Camm - One of the best experts on this subject based on the ideXlab platform.
-
Is surgery for ventricular tachycardia too risky
Clinical cardiology, 1991Co-Authors: Norbert M. Van Hemel, A. J. CammAbstract:There is strong evidence that recurrent symptomatic ventricular tachycardia (VT) after acute myocardial infarction is associated with a poor prognosis (1-year mortality varying from 12% to 54%). When successive drug trials fail to suppress VT, cardiac surgery is considered but its therapeutical value appears disputable. Recent studies show inhospital mortality after surgery varying from 5% to 23%, and the 5-year actuarial survival ranging from 33% to 71%. However, using the quality of the residual left ventricular function as criterion for operability, our recent inhospital mortality diminished to 1.3%, while the 4-year actuarial survival was 85%. Arrhythmia freedom without drugs after 4 years after surgery is nowadays about 75%. These findings show that cardiac surgery might be a very acceptable alternative therapy in surgical candidates, in particular when one or more risk factors become apparent after acute myocardial infarction. This article describes the current position of arrhythmia surgery in relation to drug therapy and the Implantable Automatic Defibrillator.
Norbert M. Van Hemel - One of the best experts on this subject based on the ideXlab platform.
-
Is surgery for ventricular tachycardia too risky
Clinical cardiology, 1991Co-Authors: Norbert M. Van Hemel, A. J. CammAbstract:There is strong evidence that recurrent symptomatic ventricular tachycardia (VT) after acute myocardial infarction is associated with a poor prognosis (1-year mortality varying from 12% to 54%). When successive drug trials fail to suppress VT, cardiac surgery is considered but its therapeutical value appears disputable. Recent studies show inhospital mortality after surgery varying from 5% to 23%, and the 5-year actuarial survival ranging from 33% to 71%. However, using the quality of the residual left ventricular function as criterion for operability, our recent inhospital mortality diminished to 1.3%, while the 4-year actuarial survival was 85%. Arrhythmia freedom without drugs after 4 years after surgery is nowadays about 75%. These findings show that cardiac surgery might be a very acceptable alternative therapy in surgical candidates, in particular when one or more risk factors become apparent after acute myocardial infarction. This article describes the current position of arrhythmia surgery in relation to drug therapy and the Implantable Automatic Defibrillator.
M.t. La Rovere - One of the best experts on this subject based on the ideXlab platform.
-
Baroreflex sensitivity as a new marker for risk stratification
Zeitschrift für Kardiologie, 2000Co-Authors: M.t. La RovereAbstract:As the atrial baroreflex importantly contributes to modulation of the autonomic influences on the heart and thereby arrhythmogenesis, baroreflex sensitivity has been used as a measure of the interaction between sympathetic and parasympathetic activities at the cardiac level. The most widely applied technique both in the experimental and clinical setting is the measurement of the heart rate slowing in response to a blood pressure rise induced by small intravenous boluses of phenylephrine. Baroreflex sensitivity is expressed as ms/mmHg and prevailing vagal reflexes and reflected by the wider R-R interval lengthening. The experimental evidence that the occurrence of ventricular fibrillation was inversely related to baroreflex sensitivity, opened the way to clinical studies. The ATRAMI (Autonomic Tone and Reflexes After Myocardial Infarction) trial has definitely demonstrated not only that a depressed baroreflex sensitivity (< 3 ms/mmHg) is a strong risk factor for cardiac death, but also that the information gained by the analysis of autonomic markers adds to the information obtained by better recognized measures of cardiovascular outcome such as left ventricular function and ventricular arrhythmias. The value of a depressed baroreflex sensitivity as a risk stratifier is meaningful in patients below age 65 in combination of a simultaneously depressed left ventricular ejection fraction. In these patients, the analysis of autonomic activity might be of value in the identification of patients who may need an Implantable Automatic Defibrillator for primary prevention of sudden cardiac death.
-
Baroreflex sensitivity as a new marker for risk stratification.
Zeitschrift fur Kardiologie, 2000Co-Authors: M.t. La RovereAbstract:As the arterial baroreflex importantly contributes to modulation of the autonomic influences on the heart and thereby arrhythmogenesis, baroreflex sensitivity has been used as a measure of the interaction between sympathetic and parasympathetic activities at the cardiac level. The most widely applied technique both in the experimental and clinical setting is the measurement of the heart rate slowing in response to a blood pressure rise induced by small intravenous boluses of phenylephrine. Baroreflex sensitivity is expressed as ms/mmHg and prevailing vagal reflexes are reflected by the wider R-R interval lengthening. The experimental evidence that the occurrence of ventricular fibrillation was inversely related to baroreflex sensitivity, opened the way to clinical studies. The ATRAMI (Autonomic Tone and Reflexes After Myocardial Infarction) trial has definitely demonstrated not only that a depressed baroreflex sensitivity (< 3 ms/mmHg) is a strong risk factor for cardiac death, but also that the information gained by the analysis of autonomic markers adds to the information obtained by better recognized measures of cardiovascular outcome such as left ventricular function and ventricular arrhythmias. The value of a depressed baroreflex sensitivity as a risk stratifier is meaningful in patients below age 65 in combination of a simultaneously depressed left ventricular ejection fraction. In these patients, the analysis of autonomic activity might be of value in the identification of patients who may need an Implantable Automatic Defibrillator for primary prevention of sudden cardiac death.
Antoine Leenhardt - One of the best experts on this subject based on the ideXlab platform.
-
Indications for Implantable Automatic Defibrillators: critical analysis
Archives des maladies du coeur et des vaisseaux, 2003Co-Authors: O. Thomas, Coumel P, Fabrice Extramiana, Paul Milliez, Bruno Cauchemez, Antoine LeenhardtAbstract:The Implantable Automatic Defibrillator (IAD), invented in 1980, has revolutionised the management of patients with malignant ventricular arrhythmias resistant to medical treatment or ablation procedures. The number of devices implanted continues to increase in the industrialised countries and, based on the results of clinical trials, the indications for IAD are now well codified and increase as new clinical studies are published. However, the absolute number of implantations in France remains low (about 1200 to 2000, about 20 per million population) for a number of reasons: cost of IAD, absence of reimbursement by the health service which has restrained the implantation to public hospitals, and information of cardiologists for whom IAD may seem to be reserved for a few exceptional cases. Several factors suggest that the number of implantations will increase in the near future. First of all, the procedures of implantation have become much more simple due mainly to technical improvements. Then, the results of recent studies have validated prophylactic implantations of these devices in primary prevention in the post-infarction period (MADIT, MUSTT, MADIT II studies) and have demonstrated the superiority of IAD over antiarrhythmic drug therapy in terms of global survival in patients with severe ventricular arrhythmias (AVID, CIDS, CASH studies).
-
Implantable Automatic Defibrillators in the treatment of ventricular tachycardia
Archives des maladies du coeur et des vaisseaux, 1998Co-Authors: Antoine Leenhardt, O. Thomas, Coumel PAbstract:The Implantable Automatic Defibrillator (IAD) is the treatment of choice of malignant ventricular arrhythmias or those resistant to pharmacological or ablative techniques. However, the small number of implantations in France, the presence of many different models, the cost and sophistication of the latest models explain why IAD remain a poorly known therapeutic method because it is highly specialised and reserved for cardiological departments with a rhythmological interest. Several factors suggest that the number of implantations will increase in the future. Firstly, the techniques of implantation have been considerably simplified and associated with technological improvements of the devices, and, secondly, publication of several trials (MADIT, AVID), even if the conclusions in favour of IAD must be carefully interpreted, will change our methods of management of patients with severe ventricular arrhythmias. The current indications of IAD in ventricular tachycardia and future prospects are discussed in the light of new data.
-
Implantable Automatic Defibrillator. Evaluation after 8 years of use
Archives des maladies du coeur et des vaisseaux, 1991Co-Authors: Rapoport P, Antoine Leenhardt, Jean-françois Leclercq, Coumel P, Robert SlamaAbstract:The thirty nine patients (30 men and 9 women, mean age 49 +/- 14 years) who were implanted with an Automatic cardioverter Defibrillator (AICD) between October 1982 and April 1990 were reviewed retrospectively. This group included 22 patients with ischaemic cardiomyopathy (55%), 9 primary cardiomyopathies (23%) 5 ventricular tachycardias in patients with normal hearts (13%), 1 case of arrhythmogenic right ventricular dysplasia and two of mitral valve prolapse. The mean ejection fraction for the whole group was 38 +/- 14%. The indication for implantation of the AICD was life-threatening ventricular arrhythmias for which other forms of treatment were either ineffective (29 patients), impossible to assess (9 patients) or poorly tolerated (1 patient). Two patients died during the perioperative period and the follow-up is too short in two other cases. Therefore, 35 patients were studied over an average of 23.7 +/- 16 months. During follow-up, 5 patients died, 3 of progressive cardiac failure and 2 suddenly, one of whom was waiting for a replacement of an exhausted generator. The AICD never functioned in 40% of patients. In addition, it was impossible to determine for the majority of shocks delivered if they had been triggered by a sustained ventricular arrhythmia. Long term tolerance was generally good but two patients developed cardiac constriction induced by the epicardial patch electrodes. The results of this review confirm the efficacy of AICD in preventing sudden death at the expense of a low operative mortality and with good long term tolerance. Quite a large proportion of AICDs never functioned and the interpretation of the delivered shocks remains questionable.(ABSTRACT TRUNCATED AT 250 WORDS)
Michael J. Reardon - One of the best experts on this subject based on the ideXlab platform.
-
Left thoracoscopic sympathectomy and stellate ganglionectomy for treatment of the long QT syndrome.
Surgical endoscopy, 1999Co-Authors: Patrick R. Reardon, B. D. Matthews, T. K. Scarborough, A. Preciado, J. L. Marti, L. D. Conklin, A. Garson, Michael J. ReardonAbstract:The long QT syndrome (LQTS) is a rare inherited cardiac disorder that may induce fatal cardiac arrhythmias. Patients diagnosed with this disorder generally have several treatment options, including beta-blockade, cardiac pacing, an Implantable Automatic Defibrillator, or a high thoracic left sympathectomy. We report the case of a 6-year-old girl with the LQTS treated by left thoracoscopic sympathectomy and stellate ganglionectomy. The procedure was performed after an initial thorascopic attempt at another institution failed due to inadequate resection of the sympathetic chain. Operative time was 85 min and blood loss was minimal. There were no intraoperative or postoperative complications. The girl's QT interval decreased and she was discharged on the 4th postoperative day. After 9 months of follow-up, she remains asymptomatic. We conclude that the LQTS patients who fail medical treatment can be treated successfully with left thoracoscopic cervicothoracic sympathectomy. We recommend that the extent of sympathectomy for treating the LQTS be T1-T4 and either the entire stellate ganglion or at least the inferior one-third.
