Depression of cardiac pacemakers by premature impulses

Pick, Alfred; Langendorf, Richard; Katz, L. N.

doi:10.1016/0002-8703(51)90005-1

Cited by 96 publications

(13 citation statements)

References 12 publications

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“…12 Furthermore, slower heart rates mean longer periods of diastole and hence a greater opportunity for an ectopic pacemaker. 13 Because we started overdriving pacing as an adjunct to antiarrhythmic drug therapy, it is unclear whether the malignant arrhythmia was prevented only by the overdriving pacing, but we have demonstrated that it is an easy and feasible bailout therapy for an electrical storm, even in AMI.…”

Section: Discussionmentioning

confidence: 97%

Temporary Overdriving Pacing as an Adjunct to Antiarrhythmic Drug Therapy for Electrical Storm in Acute Myocardial Infarction

Kurisu

Inoue

Kawagoe

et al. 2005

Circ J

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he phenomenon of rapidly clustering episodes of ventricular fibrillation requiring multiple cardioversions is called an 'electrical storm' 1,2 and in acute myocardial infarction (AMI) important contributory factors include heightened adrenergic nervous system tone, hypokalemia, hypomagnesemia, intracellular hypercalcemia, acidosis, free fatty acid production from lipolysis and free radical production from reperfusion of the ischemic myocardium. 3,4 The current recommendations for antiarrhythmic drug therapy include class I antiarrhythmic drugs, 1 amiodarone 5 and -blocker, 2 and in Japan nifekalant, a novel class III drug, is also used. 6,7 Although overdrive suppression of refractory ventricular arrhythmia by rapid pacing has become widespread in its application since 1964, 8 there have been few reports about its effectiveness for drug-resistant electrical storm in AMI.We present a case of a patient who developed a drugresistant electrical storm even after reperfusion, which was successfully overcome with temporary overdrive pacing. Case ReportA-55-year-old man with diabetes mellitus was admitted to hospital because of chest pain on June 7 2003. On physical examination, his level of consciousness was clear, temperature 36.6°C, pulse 76 beats/min, blood pressure 120/76 mmHg and oxygen saturation 96% in room air. Auscultation revealed neither cardiac murmurs nor rales, and there were no neurological abnormalities. The admission chest X-ray did not show pulmonary congestion, but Circulation Journal Vol.69, May 2005the electrocardiogram (ECG) showed ST-segment elevation in leads V1-4 and abnormal Q wave in leads V1-3. Transthoracic echocardiography showed severe hypokinesis or akinesis of the anterior and apical walls and a left ventricular ejection fraction of 40%. He was diagnosed as anterior AMI and underwent emergency angiography, which revealed occlusion of the proximal left anterior descending artery (LAD) that was treated with stent placement. He had no symptoms after the treatment.On June 14, ventricular fibrillation occurred after frequent ventricular premature beats and cardioversion was performed (Fig 1). Because the ECG after cardioversion showed re-elevation of the ST-segment in leads V1-4, he underwent emergency angiography. Left coronary angiography showed reocclusion of the proximal LAD, which was treated with balloon angioplasty. After placement of an intra-aortic balloon pump to preserve favorable hemodynamics and prevent reocclusion, the patient returned to the coronary care unit. Ventricular premature beats appeared frequently even after the successful reperfusion and he was treated with intravenous lidocaine and magnesium sulphate.On June 15, ventricular fibrillation recurred and cardioversion was performed. Despite drug therapy (intravenous propranolol, procainamide, nifekalant (0.25-0.40 mg·kg -1 · h -1 ) and oral amiodarone (800 mg)) and mechanical ventilation performed under general anesthesia with propofol, ventricular tachycardia or fibrillation relapsed. Cardioversion was performed 29 ti...

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Section: Discussionmentioning

confidence: 97%

Temporary Overdriving Pacing as an Adjunct to Antiarrhythmic Drug Therapy for Electrical Storm in Acute Myocardial Infarction

Kurisu

Inoue

Kawagoe

et al. 2005

Circ J

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“…If there were dual retrograde pathways, there would be no reason for one-time use of the faster pathway to pro long subsequent conduction in the slow pathway; a delay in the appearance of a subsequent sinus P after an atrial extrasystole would be expected because of the well-known suppressant effect of ectopic atrial impulses on the sinus node [3], For these three reasons the overwhelming probability is that the fifth QRSs shown in figure 2 are conducted atrial extrasystoles with P'-R intervals of 0.93 and 1.10 s, respectively. The P-R interval is indeed elastic; it can stretch much further than is often realized.…”

Section: Discussionmentioning

confidence: 99%

How Long Can the P-R Interval Be?

Rusterholz¹,

Marriott²

1994

Am J Noninvas Cardiol

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“…After ventricular fibrillation had be come established, electric stimulation usually restored normal sinus rhythm, manual manipulation occasionally restored it, while ascorbic acid and acetyl choline failed. Ventricular standstill resulting from the depression of the spontaneous rhythmic activity of different cardiac pacemakers (S-A and A-V node) by premature impulses was described by Pick, Langendorf & Katz (76). They felt that this mechanism was sometimes responsible for certain clinical cases with Morgagni-Adams-Stokes attacks.…”

Section: Ventricular Fibrillation Due To Digitalis Preparations Was Smentioning

confidence: 98%

Diseases of the Cardiovascular System

Winsor¹

1952

Annu. Rev. Med.

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Phonocardiography, a diagnostic procedure introduced by Einthoven "in 1894, was employed by Counihan et al.(1) to determine the cause of the initial vibrations of the first heart sound. These low frequency, low amplitude vibrations are commonly thought to be due to atrial systole. The authors observed that these initial vibrations appeared, however, even though the atria were fibrillating and even though atrial and ventricular sys" tole were widely separated because of heart block. These data suggested that the initial vibrations might be caused by the onset of ventricular contraction through mechanisms unrelated to atrial contrac:tion, the movement of the heart in the chest, or the taking up of slack in the chordae tendineae and atrioventric ular valves before closure. Phonocardiography was also employed by Ravin & Darley (2) for the study of apical diastolic murmurs which occurred in certain patients with patent ductus arteriosus. The murmurs were similar to the mid-diastolic rumble of mitral stenosis, being low-pitched, located at the cardiac apex, and best heard with the patient in the left lateral decubitus position after exercise. The presence of these murmurs was explained by: (a) enlargement of the left ventricle causing a relative narrowing of the mitral orifice, (b) a large volume of blood traversing the mitral valve at a high rate of flow, or (c) a thin chest wall which makes blood turbulence more a udible. Cardiac catheterization has been widely employed during the past year, particularly in the field of acquired heart disease, and techniques have been improved with the development of recording instruments of high fidelity. Ellis, Gauer & Wood (3) supplied a method for recording pressure tracings by means of a miniature intracardiac manometer. Excellent illustra tions of artifact-free pulse waves from within the heart and great vessels of humans and dogs were illustrated. Helmsworth et al. (4) visualized the coronary arteries during life by retrograde catheterization of the carotid and brachial arteries in five patients. Small polyethylene or woven catheters were inserted into the ascending aorta; Diodrast (iodopyracet) or Neo Iopax (sodium iodomethamate) was forcibly injected and serial roentgeno grams were taken. The large and small branches of the coronary arteries were demonstrated among normal subjects, and failure of the coronary vessels to fill after ligation was demonstrated in 10 dogs.

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Depression of cardiac pacemakers by premature impulses

Cited by 96 publications

References 12 publications

Temporary Overdriving Pacing as an Adjunct to Antiarrhythmic Drug Therapy for Electrical Storm in Acute Myocardial Infarction

Temporary Overdriving Pacing as an Adjunct to Antiarrhythmic Drug Therapy for Electrical Storm in Acute Myocardial Infarction

How Long Can the P-R Interval Be?

Diseases of the Cardiovascular System

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