Showing papers by "Atlantic Health System published in 1999"

Regional endocardial mapping of spontaneous and induced atrial fibrillation in patients with heart disease and refractory atrial fibrillation.

Abstract: We performed simultaneous catheter mapping of right and left atrial regions at onset and during sustenance of spontaneous atrial fibrillation (AF) in patients with ischemic and/or hypertensive heart disease. Seventeen patients with structural heart disease had spontaneous and electrically induced AF episodes mapped from their onset simultaneously in multiple right and left atrial regions. Atrial premature complexes (APCs) that initiated spontaneous AF had coupling intervals ranging from 260 to 400 ms (mean 332 ± 61), most commonly arising from the lateral right atrium (31%), right atrioventricular junction (13%), atrial septum (6%), superior left atrium (25%), or inferior left atrium (25%). APC morphology on surface electrocardiograms did not correlate with origin in specific atrial regions. The earliest regions of atrial activation for the first AF cycle were the lateral right atrium (n = 5), superior left atrium (n = 4), distal or mid coronary sinus (n = 4), atrial septum (n = 2), and right atrioventricular junction at the His bundle location (n = 2). Spontaneous AF at onset usually showed discrete but irregular electrograms at virtually all right and left atrial sites mapped, with a reproducible region of AF initiation in all 8 patients with multiple events. The region of earliest atrial activation at spontaneous AF onset was in close proximity to the APC origin in 15 of 16 patients (94%), and 39 of 40 episodes (97%) mapped. Stable patterns of right and left atrial activation were observed at AF onset in 14 patients. Induced AF elicited with right atrial stimulation demonstrated different sites of earliest regional atrial activation at onset compared with spontaneous AF events in 4 of 8 patients. However, discrete intracardiac electrograms were also present in induced AF in all of the mapped atrial regions. Furthermore, the site of extrastimulus delivery in induced AF was also found to be in close proximity to the earliest region of atrial activation for the first AF beat. We conclude that spontaneous AF is initiated by APCs arising in different right or left atrial regions in patients with structural heart disease and the initial region of atrial activation in AF is in proximity to the region of APC origin. Organized and repetitive electrical activation is frequently observed in both right and left atria at AF onset. Although electrically induced AF may have different activation patterns than spontaneous AF at onset in many patients, both types of AF demonstrate organization and earliest atrial activation in proximity to the initiating APC.

Antiarrhythmic device advisories and recalls: managing an increasingly vulnerable process.

Abstract: The reporting of medical device advisories and recalls in the lay press has become an increasingly common occurrence. In disseminating a concern to the public, this process has heightened awareness, and perhaps promoted early medical contact for those at risk in the patient population. Yet, for too many health care professionals and patients, this may be the first public utterance or written word on the issue, causing concern regarding the limit. In an effort to handle these issues with sensitivity and objectivity, most organizations involved in such events often issue carefully formulated press releases along with scientific communications. It is unclear if this effort has made the process less vulnerable to miscommunication. It is clear however, that all such processes have a peculiar predilection to inspire public controversy, often without the restraint of scientific debate. In dissecting this process, it is equally important to comment on the objective elements, in other words the anatomy, as well as the psychology of such an event.

Estimating Practice Expense: Are We Forever Lost in an Accounting Labyrinth?

Abstract: amount of economic information related to medical practices. The survey asks respondents to collect and report gross costs associated with medical practice expenses. In contrast to the prior approach used hy HCFA wherein individual components of practice expense were compiled and valued based on recommendations from expert panels and availahle data (the \"hottom up\" approach), this method used actual total expenditures from surveyed practices without attempting to segment expenses. This is often a telephonic survey of demographic, economic, and clinical data. It is estimated that 130 or fewer cardiology practices responded to this telephone survey and only a fraction may have included economic information. Data on the surveys have not heen made widely availahle. It is reasonable to conclude that even a limited amount of data on pacing and electrophysiology practices was probably not included. It is not clear, however, if these latter practices are distinct from the cardiology practices polled. The data collected by expert panels on practice expense were largely discarded and were used only for purposes of relative valuation of codes within a given specialty. This new methodology, when analyzed, for a prototype code such as echocardiography, valued clinical work, materials, and supplies at 30%, and equipment at 5% of the calculations based on the expert panel recommendations of practice expense. A practice expense value of $83/hour has been derived from this methodology for cardiology. This is in the upper 40th percentile for all practice expense values for all specialties. However, this value is dependent in part on a correction applied for the time expended by the physician in delivering care. Cardiology has the largest number of work hours per week, which, in turn, depressed this value. Introduction