ABSTRACT
BACKGROUND: In isolated sinus node disease single lead atrial stimulation is recommended. However, an inherent risk includes emerging AV node disturbances with serious bradycardia in the follow-up. This possible scenario frequently results in the implantation of an additional ventricular lead. PATIENTS AND METHODS: In this single-centre retrospective study the interval between 1982 and 2007 was analysed. During this period a total of 6,309 antibradycardia pacemakers were implanted for the first time. Ten percent (n=631) of these devices were single lead atrial pacemakers for treatment of the sick sinus syndrome (SSS). In these 26 years 136 pacemaker replacement operations were performed. During this procedure a thorough reevaluation of the stimulation mode was done. RESULTS: In 80.6% (n=112) AAI(R) was continued, in 10.1% (n=14) the system was upgraded to DDD(R), and in 9.3% the mode was changed to VVI(R). There were no significant differences in the lifetime of the AAI(R) pacemakers up to the time of this operation: 7.9 vs 6.3 vs 7.0 years. CONCLUSION: The single lead atrial pacing mode in SSS is mostly safe also in the long term. A premature change of stimulation mode is rarely necessary.
Subject(s)
Bradycardia/therapy , Cardiac Resynchronization Therapy , Pacemaker, Artificial , Sick Sinus Syndrome/therapy , Electrodes, Implanted , Heart Atria/physiopathology , Heart Rate/physiology , Heart Ventricles/physiopathology , Humans , Prosthesis Design , Retreatment , Retrospective Studies , Sick Sinus Syndrome/physiopathologyABSTRACT
BACKGROUND: As of October 1, 2003, a new government-initiated legislative basis for undergraduate medical education was initiated in Germany which resulted in substantial changes to the structure of the medical curriculum and in a heightened teaching load. METHODS: The Medical Faculty of the University of Dresden established an interdisciplinary reform curriculum in 1998. Since then a hybrid model of traditional lectures, seminars, practical and problem-based learning courses has been implemented for all courses in undergraduate medical training (Dresdener Integrated Problem-based Learning: DIPOL). RESULTS: Examplarly for all other DIPOL courses, the 2003 evaluation results of the "Emergency medicine-Injuries-Intensive care medicine" are presented and show that the course was very well received by students and tutors, and that 95% of the students passed the exams. CONCLUSIONS: The DIPOL anesthesiology course conforms with the new German federal law. A continuous further evaluation is an essential part of quality control and is necessary for the further development of a new curriculum.
Subject(s)
Anesthesiology/education , Critical Care , Emergency Medicine/education , Anesthesiology/legislation & jurisprudence , Curriculum , Education, Medical, Undergraduate/legislation & jurisprudence , Germany , Problem-Based Learning , TeachingABSTRACT
Eight cases of Lyme borreliosis of clinical certainty with carditis are reported. In six patients, AV-blocks were predominant, two patients had a myopericarditis. Six acute cases were seropositive, but one case remained seronegative. The titer was border-line in that patient, who was studied 4 years after the acute disease. A Lyme carditis should be considered in each case, in which AV-blocks appear acutely.
Subject(s)
Electrocardiography , Heart Block/physiopathology , Lyme Disease/physiopathology , Myocarditis/physiopathology , Adult , Antibodies, Bacterial/analysis , Atrioventricular Node/physiopathology , Borrelia/immunology , Diagnosis, Differential , Female , Humans , Male , Middle AgedABSTRACT
Issuing from the own experiences on 110 patients with a heart stimulation including the atrium, advantages and disadvantages as well as possibilities of a complication in physiological stimulation system are discussed. From the differential indications for the pacemaker therapy are derived. It is estimated that approximately 20% of the new implantations in critical indication should be performed by a form of physiological stimulation.
Subject(s)
Arrhythmias, Cardiac/therapy , Pacemaker, Artificial , Electrocardiography , Follow-Up Studies , Heart Block/therapy , Humans , Myocardial Contraction , Sick Sinus Syndrome/therapySubject(s)
Cardiomyopathies/pathology , Sarcoidosis/pathology , Biopsy , Female , Humans , Middle Aged , Myocardium/pathologyABSTRACT
Case report from a 57 years old woman with pulmonary and heart sarcoidosis. The diagnosis was confirmed by heartcatheterism with myocardial biopsy from the left ventricle.
Subject(s)
Cardiomyopathies/pathology , Sarcoidosis/pathology , Biopsy , Female , Humans , Lung/pathology , Lung Diseases/pathology , Middle Aged , Myocardium/pathologyABSTRACT
In order to induce higher-degree AV block, ventricular pacing at a rate of 150/min after ajmaline administration (max. doses 100 mg) was performed in patients with fascicular block. Out of 109 patients with clinically and electrocardiographically documented intermittent complete AV block (group A) and 61 patients with a typical history without ECG manifestations of higher-degree AV block (group B), a total of 145 patients (85.3%) showed 2nd or 3rd degree AV block after pacing. In contrast to this, only 3 out of 38 patients with bifascicular block without syncope (group C) presented positive results. The method is regarded as being suitable for detecting latent trifascicular blocks.
