Implantation Sites of Pacemakers After Right Ventriculotomy and Complete Heart Block

Klotz, Donald H.; Lister, John; Jomain, Serge L.; Hoffman, Brian F.; Stuckey, Jackson H.

doi:10.1001/jama.1963.63710100013013d

Cited by 29 publications

(10 citation statements)

References 8 publications

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“…Therefore, differences due to sequence of ventricular activation might have been obscured by a variety of compensatory cardiovascular reflexes. The apparent lack of agreement of the experiments mentioned above with those of Klotz et al, 1 which showed hemodynamic differences related to pacer site, may be due to differences in compensatory phenomena under various experimental conditions and to differences in experimental design.…”

Section: Discussionmentioning

confidence: 76%

“…Reports are conflicting, with some investigations showing marked differences in cardiac function dependent on excitation order and others showing little or no difference. Although Klotz et al have reported differences in cardiac output with regular pacing from various ventricular sites, 1 two other groups using regular ventricular pacing found only small variations in cardiac performance. 2 ' 3 While there is lack of agreement that cardiac performance is significantly altered by stimulus site during ventricular pacing at a fixed rate, there is general agreement that variations in performance related to stimulus site do occur with ventricular premature beats.…”

mentioning

confidence: 94%

“…The sites of premature stimulation used in this study are: 1 trol, between 120 and 150 beats/min. Similar recording electrodes were applied to one atrial and one ventricular site to observe temporal relations.…”

mentioning

confidence: 99%

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Relation of Variations in Activation Order to Intraventricular Pressures during Premature Beats

Millar

Eich

Abildskov

1966

Circulation Research

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A comprehensive study on open chest anesthetized dogs was done to investigate the influence of intraventricular activation order on cardiac performance and to evaluate the degree to which entry into the conduction system might contribute to the synchrony of contraction in the ventricle opposite the stimulus site. Intraventricular pressures were measured during premature beats from several ventricular sites and over the entire range of the cardiac cycle. For each site, intraventricular pressures during the premature beats were plotted vs. time of delivery of the stimulus and also vs. time of onset of pressure rise in the ventricle being considered. The prior observation that higher ventricular pressures occur during premature beats initiated in the opposite ventricle was confirmed. Evidence is presented that the major factor responsible is the increased filling and recovery interval permitted by the conduction time of the activation front arriving from the opposite ventricle. After correction for filling and recovery time, there were still differences due to site of origin of the premature beat, with those delivered to the apex resulting in the highest left ventricular pressures. The hypothesis that a more synchronous contraction results from stimulation of sites on the contralateral, rather than the ipsilateral ventricle, was not substantiated. While there is lack of agreement that cardiac performance is significantly altered by stimulus site during ventricular pacing at a fixed rate, there is general agreement that variations in performance related to stimulus site do occur with ventricular premature beats. During premature ventricular beats, marked and systematic differences in the intraventricular pressure in the stimulated and contralateral ventricle have been noted, with the directly stimulated ventricle attaining a smaller fraction of the systolic pressure in that ventricle during the preceding normally conducted beat.4 ' 6 Wiggers noted this difference and suggested that the excitation pattern is more

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Section: Discussionmentioning

confidence: 76%

mentioning

confidence: 94%

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Relation of Variations in Activation Order to Intraventricular Pressures during Premature Beats

Millar

Eich

Abildskov

1966

Circulation Research

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“…Lastly, the rate of stimulation may be of importance. It has been demonstrated that runs of spontaneous ventricular Circilatio,n, Voluime XXX, October 1964 tachycardia and fibrillation can be suppressed by electrical stimulation of the ventricles faster than a critical rate that varies widely from patient to patient.20 In all three reported cases of repetitive firing the corresponding ventricular cycles preceding the T waves on which stimuli produced repetitive ventricular arrhythmias were 0.9 second or longer. No satisfactory explanation has been offered for enhanced propensity for fibrillation at slower rates.…”

Section: Discussionmentioning

confidence: 96%

“…If the pacemaker stimulus appeared later in the cycle, only single ventricular complexes would result. The conduction of these ventricular complexes was aberrant, as compared with the complexes evoked by the pacemaker during diastole, if their onset appeared early enough to interrupt the T Circulation, Volume XXX, October 1964 wave. As artificial stimuli fall earlier in the terminal portion of the electrical systole, there is an increasing latent period between stimulus and the ultimately resulting ventricular excitation, which ranges from 0.01 to 0.08 second.…”

Section: Discussionmentioning

confidence: 99%

Repetitive Ventricular Arrhythmia Resulting from Artificial Internal Pacemaker

1964

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We have presented a case summary of a patient in whom several periods of repetitive ventricular arrhythmia—at times indistinguishable from fibrillation—were induced by artificial internal pacemaker stimuli falling in the T wave of a preceding cycle (the vulnerable period). Ours is the third such case to be reported and, although this repetitive response is said to be rare, the exact incidence remains to be determined. The theoretical and clinical implications are discussed and possible explanations are given for why such small artificial stimuli are capable of evoking such serious arrhythmias in certain patients. We also have suggested measures that might reduce the likelihood for this complication to arise.

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Epicardial electrode implantation on both right and left ventricles using local anaesthesia

Guharay

et al. 1974

Journal of British Surgery

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Experience with a simple method of epicardialintramural pacer lead implantation on either ventricle using local anaesthesia for long term cardiac pacing in casesof symptomatic heart block ispresented. The report concerns 40 patients with 41 implants. The follow-up period was 6-19 months. There were 3 operative deaths. One ofthe deaths was coincidental and the other 2 were attributed to bad selection. Early electrode failure due to the development of an exit block occurred in 1 case; he has done well after his right ventricular electrode was transferred to the left ventricle through the same incision using local anaesthesia. There has been no late electrode failure. Nearly all the survivors have obtained excellent results. The distinct advantages offered by this technique of epicardial pacing are discussed. The mod$cation which has been introduced in extending the scope of pacer lead implantation to the left ventricle has increased the usefulness of the technique. Left ventricular placement of the electrode assures better intramural pacing.

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Implantation Sites of Pacemakers After Right Ventriculotomy and Complete Heart Block

Cited by 29 publications

References 8 publications

Relation of Variations in Activation Order to Intraventricular Pressures during Premature Beats

Relation of Variations in Activation Order to Intraventricular Pressures during Premature Beats

Repetitive Ventricular Arrhythmia Resulting from Artificial Internal Pacemaker

Epicardial electrode implantation on both right and left ventricles using local anaesthesia

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