Showing papers by "Sanjeev Saksena published in 1984"
TL;DR: i.v. amiodarone has limited value in acute control of VT and clinical or electrophysiologic response to it is not predictive of long term therapeutic results with amiodrone.
Abstract: The clinical efficacy and electropharmacologic effects of continuous inllravenous (i.v.) amiodarone infusion (10 to 20 mg/kg/day for 4 to 7 days) followed by chronic oral amiodarone therapy (400 to 800 mg/day for 24 to 53 days) were evaluated in 17 patients with refractory sustained ventricular tachycardia (VT) or ventricular fibrillation. Intravenous amiodarone infusion prolonged the RR interval (from 754 ± 85 to 860 ± 157 ms, p from 423 ± 22 to 466 ± 31 ms, p 0.05) but prolonged significantly after chronic oral amiodarone (p = 0.025). Mean serum amiodarone concentration was 1.7 ± 1.0 mg/liter with infusion and 1.5 ± 0.6 mg/liter with oral therapy. Intravenous amiodarone infusion suppressed spontaneous VT in 5 of 9 patients with frequent VT recurrences, but had no effect on cycle length of spontaneous VT. Chronic amiodarone therapy either suppressed spontaneous VT recurrences or prolonged cycle length during VT recurrences. VT induction after i.v. amiodarone was not predictive of VT induction or spontaneous VT recurrences after chronic oral amiodarone treatment. Thus, i.v. amiodarone has limited value in acute control of VT and clinical or electrophyslologic response to it is not predictive of long term therapeutic results with amiodarone.
64 citations
TL;DR: The acute effects of rapid ventricular pacing and sustained ventricular tachycardia on left ventricular function were examined in patients with recurrent sustained ventillary tachy Cardiac Arrest and the results confirmed the importance of knowing the timing and intensity of these events in the determination of ventricular Function.
45 citations
TL;DR: The clinical and economic results of antiarrhythmic therapy selected on the basis of electrophysiologic (EP) studies in patients with recurrent ventricular tachycardia (VT) were examined and compared with previously administered empiric therapy.
Abstract: The clinical and economic results of antiarrhythmic therapy selected on the basis of electrophysiologic (EP) studies in patients with recurrent ventricular tachycardia (VT) were examined and compared with previously administered empiric therapy. Twenty-nine patients with recurrent VT and organic heart disease, aged 39 to 78 years (mean 59 ± 11) were evaluated. All patients had empiric therapy before EP studies and EP-based therapy after EP evaluation. Hospital records were analyzed from arrhythmia diagnosis 1 to 39 months (mean 7.5 ± 10.4) before EP evaluation until completion of follow-up 1 to 20 months (mean 13.3 ± 7.4) after EP studies. Clinical efficacy was assessed by comparing actual arrhythmic deaths or recurrences during EP-based therapy with predicted values on empiric therapy. Charges based on diagnosis-related groupings for empiric and EP-based therapy were compared. Charges for EP evaluation were included in the calculation for EP-based therapy. During empiric therapy, 1 to 7 unsuccessful drug trials (mean 3.7 ± 1.6) were performed, with arrhythmia recurrences noted in all patients during a mean 7.5-month VT duration. Twenty-seven of 29 patients required 1 to 70 electrical terminations. There were 64 hospitalizations (mean 2.1 ± 1.7) with a total length of hospital stay of 913 days (mean 31.0 ± 19.9). EP evaluation required 90 EP procedures (mean 3.0 ± 1.5) with a length of stay of 690 days (mean 23.8 ± 12.0). During a follow-up period of 1 to 26.5 months (13.3 ± 7.4) on EP-based therapy, 1 patient died suddenly. There were 5 repeat hospitalizations for adverse effects with a total length of stay of 48 days (mean 1.7 ± 5.1). There is a significant reduction in arrhythmia recurrences and sudden death (p
44 citations
TL;DR: 2DE is feasible during clinical electrophysiologic studies for sustained VT and may be a useful adjunct in studying the physiologic impact of VT; WMA generally worsens during VT but can appear less evident due to declining systolic function in adjacent viable myocardium.
Abstract: We evaluated left ventricular function in patients with recurrent sustained ventricular tachycardia (VT) using two-dimensional echocardiography (2DE). Thirteen patients, 11 men and 2 women, age range 42-77 (mean 62 +/- 12) years were studied in sinus rhythm (SR) and immediately after VT induction. 2DE parameters analyzed included wall motion, mitral valve leaflet motion, and ejection fraction (EF). In SR, 21 segments/walls in 12 patients showed wall motion abnormalities (WMA) ranging from hypokinesis to dyskinesis and one patient had generalized LV hypokinesis. In VT, new WMA were noted in 2 patients. Thirteen segments/walls in 8 patients showed further worsening of pre-existing WMA. In 1 patient there was worsening of generalized LV hypokinesis. Three patients showed apparent improvement in pre-existing WMA during VT. In 2 patients large apical aneurysms showed a reduction of dyskinesis in VT. Mitral valve opening was intermittent in patients with shorter VT cycle lengths and was maximal when atrial systole preceded or coincided with ventricular depolarization. Doppler echocardiography in 1 patient confirmed the pattern of intermittent mitral flow, with greatest flow occurring when mitral valve opening occurred well before the QRS peak. In 5 patients, 2DE permitted EF measurements. EF in SR ranged from 24-56% (mean 36 +/- 13), decreased to 6-33% (mean 21 +/- 11) within the first ten beats of VT and 6-25% (mean 19 +/- 8) after twenty beats of VT. EF decreased more in patients with shorter VT cycles as compared to those with longer VT cycle lengths.(ABSTRACT TRUNCATED AT 250 WORDS)
13 citations