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Query: UMLS:C0243026 (sepsis)
 52,417 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

In conducting 381 stimulations in 330 patients with brady- and tachysystolic disorders of cardiac rhythm of various etiology 122 complications were revealed. Dislocation of the electrode was noted in 71 cases (18.6%), perforation of the myocardium by the endocardial electrode in 9 (2.1%), ventricular fibrillation in 11 (2.3%), and sepsis in 5 (1.3%) of the cases. A special device may be used for the immediate detection of dislocation. Characteristic changes are noted on the intracardiac ECG in penetration of the electrode into the myocardium (precursor of perforation).
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PMID:[Hazards and complications of temporary endocardial stimulation]. 35 53

An experience with penetrating cardiac injuries between 1974 and 1977 has permitted designation of particular findings as indications for emergent operations and appropriate therapeutic approaches. Of the 46 patients with cardiac trauma, 28 suffered gunshot wounds. Seventeen patients died, and 14 of the deaths occurred as a result of asystole, ventricular fibrillation or exsanguination during operation. Two patients died of neurologic sequelae following successful cardiac repair, and one died secondary to injury not disclosed by physical examination or roentgenogram. The surviving 29 patients had five major complications. Sepsis, organ system failure and cardiac defects rarely occurred despite rapidly performed thoracotomy and severe shock. Since delayed operation has been uniformly associated with adverse outcome and because postoperative complications of emergent pericardial exploration are mild, the following conclusions have been reached: 1) Mediastinal entrance wounds, severe hypotension and signs of cardiac tamponade are demonstrative of cardiac trauma. Therefore, virtually any combination of these physical signs mandates pericardial exploration. 2) Subxiphoid or transdiaphragmatic exploration (during laparotomy) of the pericardium has been valuable in diagnosis of suspected heart wounds. 3) Emergent cardiorrhaphy is the treatment of choice. Pericardiocentesis is at best only temporarily effective. Thoracotomies performed in the emergency room were uniformly unsuccessful. If possible, cardiorrhaphy should be done in the operating room. 4) Median sternotomy is the approach of choice. 5) The basic principles of management of cardiac injury are rapid diagnosis, relief of tamponade, control of hemorrhage, repair of cardiac defects and restoration of blood volume.
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PMID:Principles for the management of penetrating cardiac wounds. 45 48

4 patients (P) with recurrent, sustained ventricular tachycardia (VT) resistant to medical treatment, underwent surgery for cure of this arrhythmia. Each P had episodes of VT lasting 30 or more seconds, 3 of them had episodes of ventricular fibrillation. In all cases rhythm disturbances were secondary to post myocardial infarction aneurysm. Coronary angiography showed in all P total occlusion of LAD, in 2 cases significant lesion in RCA were found. 1 P had lung cancer. All P underwent aneurysmectomy and an excision of the altered endocardium by Harken's method. The endocardial excision was performed without endocardial mapping. 2 P had concomitant CABG to RCA. In the P with lung cancer lobectomy was performed. There were 2 ++non-arrhythmic death. The P with lung cancer died because of sepsis due to lung abscess. One P died because of heart failure (preoperative EF 10%), 6 months after the surgery. The 2 survivors remained free of VT during a follow-up period 8 months. In conclusion, endocardial excision by Harken's method is efficient in treating recurrent sustained VT, resistant to medical treatment, in patients with post myocardial infarction aneurysm. The surgical procedure can be performed without intraoperative endocardial mapping.
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PMID:[Surgical treatment of ventricular tachycardia in patients with post-infarction aneurysms]. 147 71

The Vienna heart uses a vacuum formed, pellethane pulsatile ventricle and is available in left ventricular assist (LVAD) and total artificial heart (TAH) configurations. This device was used as mechanical support of the failing heart in nine patients intended for heart transplantation. In two patients with cardiomyopathy an orthotopic TAH was implanted; one survived despite severe preoperative ischemic liver damage, and the other died of sepsis. In seven patients an atrio-aortic LVAD was implanted; six had suffered an acute myocardial infarction with cardiogenic shock, and one could not be weaned off bypass. Three patients survived. These included one 65-year-old with incipient ARDS at operation, and a 40-year-old with preoperative liver and kidney insufficiency who was transplanted in septicemia. In this patient the septic focus, natural and artificial heart, were removed at transplantation. Four patients died. In one we were unable to establish satisfactory circulation, one died after failure of the transplanted heart, one suffered a lethal cerebral embolism and one developed multi-organ failure after repeated attacks of ventricular fibrillation. With the Vienna heart sufficient circulatory support could be established with cardiac outputs between 6 and 8 l/min for the TAH and 3.5 to 4.5 l/min for the LVAD. With this type of support an overall survival rate of 44% could be achieved. Mechanical hemolysis was not a clinical problem and no device failure occurred.
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PMID:Mechanical bridge to transplantation with the Vienna heart in TAH and LVAD configuration. 152 99

Seventy-seven patients with drug refractory ventricular tachycardia (57) and ventricular fibrillation (20) received the implantable defibrillator. There were 55 men and 22 women with a mean age of 63 +/- 10 years. The anatomical diagnoses were coronary artery disease in 61 patients, cardiomyopathy in 15 patients, and aortic stenosis in one patient. The mean ejection fraction was 32 +/- 12%. Concurrent surgery at defibrillator implantation was coronary bypass in eight patients and aortic valve replacement in one patient. There were no intraoperative mortalities. The mean ventricular fibrillation termination threshold was 13 +/- 6 joules. During a follow-up period of 16 +/- 10 months (range 2-40 months) four patients died: electrical mechanical dissociation (two patients), respiratory failure, and sepsis. Thirty-eight patients (51%) continued receiving antiarrhythmic drug therapy, with quinidine sulfate and procainamide being the most frequently utilized agents. Fifty-four patients (72%) have received a mean of 9 +/- 10 shocks (range 1-44). Implantable defibrillators are often needed in patients seen in large community hospitals. This technology can be administered successfully in this setting with complications and results comparable to those reported from university hospitals. Implantable defibrillators are effective in preventing arrhythmic death and can be used with low risk to the patients.
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PMID:Long-term community hospital experience with the internal defibrillator. 170 35

Complete data concerning long-term results of transcatheter electrical ablation of the atrioventricular junction is not available. At the request of the French Cardiac Arrhythmia Working group we undertook an inquiry in October 1983. All centers potentially able to perform such procedures were asked to report their experience. Eight centers have performed one case or more, over a period of 3 years, for a total of 91 patients. The mean follow-up completed in all patients in April 1986 was 12 +/- 10 months. The procedure was indicated for a supraventricular arrhythmia resistant to a mean of 3.9 +/- 1.3 classes of antiarrhythmic agents. Atrial flutter or fibrillation in 54 (59%) and atrioventricular nodal reentry in 17 (18%) were the most common arrhythmias. A mean of 2.6 +/- 2.3 electrical shocks (range 1-14 shocks) with a stored energy of 130-400 joules was delivered during 1-5 sessions. Complete heart block was obtained in 83 patients and persisted at the time of discharge from the hospital in 46 patients (50.5%). The immediate complication (within 24 hours after the procedure) included ventricular fibrillation successfully converted (one patient) and nonsustained ventricular tachycardia (three patients). Late complications included one death 3 days after the procedure, in a patient in whom sustained ventricular tachycardia was documented, nonsustained ventricular tachycardia in two patients, sepsis in three patients and pericardial effusion in one patient. At the time of the follow-up, there were three additional deaths related to sepsis due to pacemaker pocket infection in one patient and to preexisting congestive heart failure in two patients.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Long-term follow-up of atrioventricular junctional transcatheter electrical ablation. 245 67

The prognostic role of programmed electrical stimulation and Holter monitoring was evaluated in 21 patients with idiopathic dilated cardiomyopathy who had no prior history of ventricular tachyarrhythmias. During a mean follow-up period of 23 months, sudden death or ventricular fibrillation occurred in four (20 percent). One patient died of complications of sepsis, and one underwent cardiac transplantation. Programmed electrical stimulation (PES) resulted in five or more beats of induced ventricular tachycardia in seven patients (33 percent), but was a poor predictor of sudden death (sensitivity = 20 percent). Thirteen patients (62 percent) had complex ventricular ectopy (Lown class 4A or 4B) by ambulatory monitoring. This was a sensitive (80 percent) but not specific (31 percent) marker for sudden death. The predictive value of a negative Holter monitor study was high (80 percent) for identifying those at low risk of sudden death. The results of this prospective study suggest that programmed ventricular stimulation and routine ambulatory monitoring are poor predictors of sudden death in this population.
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PMID:Idiopathic dilated cardiomyopathy. Role of programmed electrical stimulation and Holter monitoring in predicting those at risk of sudden death. 333 72

The clinical records of 339 consecutive patients who had received temporary transvenous pacemakers were analyzed for indications, complications and malfunctions. Of the 156 patients who had had an acute myocardial infarction (AMI), 50% had had anterior wall and 43.6% inferior wall involvement. The route of electrode insertion was the antecubital vein in 71%, subclavian vein in 24%, internal jugular vein in 4%, and a femoral vein in the remainder. The indication for pacing in the AMI group was atrioventricular (A-V) block in 55%, fascicular block in 32% and other arrhythmias in 13% of the cases. In the non-AMI group, the indication for pacing was A-V block in 46.4%, sick sinus syndrome in 25%, preparation for noncardiac surgery in 12%, and diagnostic purposes in the remainder. Ventricular fibrillation (VF) occurred only in the AMI group and appeared in 9 (5.66%) of these cases. The site of infarction did not significantly affect the incidence of VF. Ventricular premature beats (VPBs) and ventricular tachycardia (VT) appeared in 28.8 and 12.8% of the AMI group and 4.4 and 3.3% of the non-AMI group, respectively. No difference in the incidence of myocardial perforation, sepsis, and phlebitis was encountered between the AMI and non-AMI groups. Total malfunction rate was significantly higher in the AMI group (15%) vs. the non-AMI group (4%). A higher rate of pacing malfunction was found when a semifloating electrode was used through the subclavian vein (14.3%) vs. a 6 or 7 French electrode through the antecubital vein (7%). Thus, temporary pacing is safe and associated with lower incidence of complications and malfunctions in non-AMI than in AMI subjects. Moreover, a lower incidence of malfunction was encountered when a 6 or 7 French electrode was inserted through the antecubital vein.
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PMID:Temporary transvenous pacing: analysis of indications, complications and malfunctions in acute myocardial infarction versus noninfarction settings. 367 90

As precursors of permanent pacemakers, Lidwill (1929) and Hyman (1932) introduced temporary pacemakers for resuscitation. Callaghan (1950) intravenously paced the sinus nodal region for bradycardia in hypothermic dogs. Zoll (1952) used external electrodes to treat Adams-Stokes attacks, and Lillehei (1957) fixed stainless steel electrodes to the myocardium, successfully treating iatrogenic total atrioventricular block with a percutaneous pacemaker. Since 1951, by experimental and clinical use of ventricular fibrillation to obtain a functional cardiac standstill during open heart surgery, we used all known methods of stimulation to treat asystole or bradycardia after defibrillation. Since 1957, percutaneous stimulation by Adam-Stokes attacks has been performed. The most serious complication is infections along the electrodes causing death from sepsis. The solution of the problem was the implantation of the pacemaker and its energy supply. Percutaneous leads were used to study the different parameters for electric stimulation and to find the lowest frequency (to spare energy) with the best variation of cardiac output. In October 1958 in Stockholm a fixed rate pacemaker was implanted by thoracotomy. At present, the patient is living with his 23rd pacemaker. Four additional patients had pacemaker implantations until 1960. In 1961, Chardack and Greatbach successfully implanted pacemakers with mercury batteries. Johanson and Lagergren connected the pacemaker to an intravenous electrode to avoid thoracotomy. The enormous development in the electronic field made more elaborate pacemakers possible, and eliminated the risk of the fixed rate (interference, repetitive firing, and ventricular fibrillation).
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PMID:Cardiac pacing in retrospect. 634 75

An international registry was formed to collate data for patients undergoing attempted catheter ablation of the atrioventricular (AV) junction and insertion of a permanent pacemaker. Over the past 2 years, data was submitted for 127 patients who were followed for a mean of 9.9 +/- 8.2 months. The most common arrhythmia treated was chronic or paroxysmal atrial fibrillation or flutter (78 patients, 61%); the remainder had supraventricular tachycardia due to AV node reentry, ectopic atrial tachycardia, or incorporated an accessory pathway. A single shock of 150 to 400 J was effective in producing chronic third-degree AV block in 45 patients while two or more shocks were used in an additional 45 patients. There was no significant difference in the total cumulative energy used in successful and unsuccessful procedures. Immediate complications related to the shock included ventricular fibrillation (one patient), pericardial tamponade (one patient), and transient hypotension (one patient). No chronic sequelae occurred as a result of these complications. Late complications (1 day to 1 month) included ventricular tachycardia (three patients), sepsis involving the pacemaker pocket (two patients), staphylococcal sepsis from temporary pacing catheter (one patient), thrombophlebitis (one patient), thrombosis of the left subclavian vein (one patient), and hemothorax (one patient). Follow-up evaluation revealed chronic third degree AV block in 90 (71%) and AV conduction resumed but no drugs were required for arrhythmia control in eight (6.5%) and arrhythmia control was achieved with previously ineffective drugs in 16 (13%). Thirteen patients (10%) had no improvement and five of these patients underwent cardiac electrosurgery for direct His bundle ablation.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Catheter ablation of the atrioventricular junction: a report of the percutaneous mapping and ablation registry. 649 41


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