Catheter aided repositioning of a displaced permanent pacemaker lead.

A 91-year-old woman, who had a pacemaker implanted in 1977, underwent replacement of a pulse generator and lead in 1995 because of recurrent syncope. The new lead dislodged the next day and migrated to the pulmonary artery. Because of her dependence on continued pacing, repeated resuscitation was required. Considering her advanced age and the impact of cardiopulmonary resuscitation on her general condition, we attempted catheter aided repositioning of the pacemaker lead. The procedure was technically successful; lead position was stable and optimal pacing parameters were attained. She was discharged in good condition.

A three-site programmed electrical stimulation protocol in patients with and without ventricular tachyarrhythmias.

Programmed electrical stimulation (PES) of the ventricle plays an important role in diagnosis and in testing the effect of pharmacological and non-pharmacological therapy of ventricular tachyarrhythmias. A stimulation protocol should reliably reproduce clinical ventricular tachyarrhythmia. The authors compared the results of the standard one-site protocol to those of a new test delivering extrastimuli alternately into the right and left ventricle. In group I (control group, n = 37), clinically without ventricular tachycardia, tachycardia could not be induced in any of the patients. In group II (n = 30), with clinical ventricular tachycardia, inducibility was in 22 patients using the standard test, and in 23 patients using the new test. The authors conclude that this modification of the PES protocol with alternate extrastimulus delivery into the right and left ventricle does not seem to contribute significantly to PES sensitivity compared to the standard one-site stimulation protocol. It is not clear whether or not another stimulation protocol with alternate stimulus delivery to both ventricles or to different sites in the right ventricle will raise the sensitivity, specificity and reproducibility of the PES test.

[24-hour effect and tolerance for perindopril (Prestarium) in mild and moderate essential hypertension]. / 24hodinová úcinnost a tolerance perindoprilu (Prestarium) u mírné az stredne tezké esenciální hypertenze.

A multicentre investigation of antihypertensive treatment by perindopril was conducted in three centres of Czechoslovakia. The investigation comprised 51 patients with mild to moderate essential hypertension (diastolic pressure 95-115 mmHg) who were taking perindopril for a period of three months, the initial dose being 4 mg (1 tablet per day). If the blood pressure did not drop to normal levels (dBP < 90 mmHg), the dose was increased to 8 mg after 1 month and if after 2 months of treatment the blood pressure did not reach normal levels, a thiazide diuretic was added. The antihypertensive effectiveness was assessed 24 hours after ingestion of the drug. The blood pressure declined significantly already after the first month of monotherapy with perindopril. It declined then significantly up to the end of the 3rd month of treatment. The systolic blood pressure declined by 9.4 mmHg after the first month of monotherapy with perindopril and by 15.9 mmHg after 3 months of treatment. The diastolic blood pressure declined by 8.1 mmHg after one month of monotherapy and by 12.4 mmHg at the end of three-month treatment. The clinical and biological tolerance was excellent and only one patient discontinued treatment for reasons not related to the administered drug. Twenty-four hour monitoring of the blood pressure also proved the favourable effect of perindopril.

Changes in ventricular effective refractory periods after two extrastimuli and ventricular electrical instability.

Using programmed stimulation with one and three extrastimuli delivered in the right ventricular apex, we compared the effective refractory period (ERP) during sinus rhythm (ERP-SR) and during the third extrastimulus (ERP-S3) in patients without ventricular tachycardias (control group, n = 87) and in patients with documented ventricular tachycardia (VT group, n = 76). The protocol was not completed to determine ERP-S3 in one patient in the control group and in 15 patients in the VT group. We observed a significantly greater change (i.e., shortening) in ERP after two extrastimuli in the VT group compared with patients without VT (delta ERP = 45 +/- 20 msec in the control group and 70 +/- 16 msec in the VT group, P < 0.001). This electrophysiological phenomenon, along with conduction delay, may play an important role in VT induction.

Bopindolol: Czechoslovak experience with a new beta blocker in the treatment of hypertension.

Bopindolol is a nonselective beta blocker with mild intrinsic sympathomimetic activity. One of the drug's main benefits is its prolonged effect, lasting for 24 hours, which makes it possible to administer bopindolol in a single daily dose, a fact that may improve patient adherence to therapy. A double-blind study was performed in two centers, comparing bopindolol with metoprolol in 86 hypertensive patients. Baseline diastolic blood pressure (BP) was 100 to 120 mm Hg. The effects of bopindolol or metoprolol on BP and heart rate were similar: return to normal values was achieved in 70% of patients with either drug. A 6-month study at another center found that bopindolol did not affect the levels of total cholesterol, low-density and high-density lipoprotein cholesterol or triglycerides. Another 12-month study documented a decrease in total cholesterol, apolipoprotein (apo) A1 and apo B. The apo A/B ratio rose, thus improving the atherosclerotic index. No deterioration of glucose tolerance or immunoreactive insulin response to glucose was seen after 6 months of bopindolol administration. Bopindolol satisfactorily modifies not only resting but also exercise BP during isometric and isotonic load, thus reducing BP fluctuation during physical activities of the hypertensive patient. The drug exerts no effect on renal and liver function, electrolyte balance and hematologic parameters. Bopindolol is a very useful drug of first choice in mild and moderate hypertension. Bopindolol's main advantages include its prolonged action, good tolerance and a beneficial effect on risk factors of atherosclerosis (lipid and carbohydrate metabolism).

Effect of isradipine on 24-h blood pressure profile demonstrated by repeated monitoring.

The antihypertensive effect of isradipine was assessed by repeated 24-h ambulatory blood pressure monitoring. Using an SPS device (Sandoz Pharma, Basel, Switzerland), monitoring was carried out in 10 male patients with mild essential hypertension (1) after a placebo period, (2) after six months, and (3) after 12 to 13 months of treatment with isradipine (average dose 2.5 mg twice daily). Mean 24-h blood pressure decreased significantly after both periods 2 and 3 (from 148/93 mm Hg to 137/87 and 130/85 mm Hg, respectively). The total number of hypertensive systolic and diastolic blood pressure values also decreased. The normal circadian blood pressure curve was preserved, showing the reduction throughout the 24-h period, and the early morning rise in blood pressure was markedly blunted. These results indicate that isradipine has a favorable effect on the 24-h blood pressure profile that persisted throughout six and 12 months of antihypertensive therapy.

[Beta-blockers in the treatment of hypertension in elderly patients]. / Betablokátory v lécbe hypertenze starsích osob.

The authors investigated the effectiveness of treatment of hypertension by monotherapy with beta-blockers--bopindolol (a beta-blocker with a slightly expressed ISA) and metoprolol (cardioselective beta-blocker) in 86 subjects with mild and medium severe hypertension. The purpose of the work was to analyze the effectiveness of control of hypertension in relation to age and to compare groups of subjects under 40 years with patients above 60 years of age. Both investigated beta-blockers proved effective in 80% of subjects above 60 years in the control of hypertension; no serious side-effects were recorded.

24-hour ambulatory blood pressure monitoring in the treatment of mild hypertension with isradipine.

Twenty-four-hour ambulatory blood pressure (BP) monitoring allows the physician to follow the course of blood pressure of a patient at the worksite, at home, and during sleep. All these undisputed advantages made the technique an important part of studies designed to assess the effect of new antihypertensive drugs. In a study involving 14 patients with mild hypertension. 24-hour BP levels were monitored before and after treatment with isradipine (Lomir, Sandoz), a new calcium antagonist. A marked decrease in mean systolic BP (146.8 +/- 4.1 vs. 133.8 +/- 3.3 mmHg, p less than 0.01) as well as diastolic pressure (92.4 +/- 1.4 vs. 86.0 +/- 1.1 mmHg, p less than 0.01) was found after 6-month therapy compared with the values determined in the placebo period. The incidence of hypertensive BP values during the day was likewise reduced. The circadian rhythm of BP was retained. The nocturnal decrease in BP was less prominent than during the day, and there was a marked reduction in the rapid morning rise in BP. Overall, 24-hour BP monitoring demonstrated a favourable effect of isradipine on the diurnal profile of BP.

Bopindolol in the treatment of hypertension: a double blind study comparing bopindolol and metoprolol.

The article presents the experience gained with a new betablocker- bopindolol-in the treatment of hypertension. Using a three-month double blind study conducted in 2 centres, the antihypertensive effect of bopindolol and metoprolol was compared in a total of 86 patients. The incidence of undesirable effects was determined, and biochemical parameters before and after therapy were followed up. Both drugs were equally effective in controlling blood pressure. In 70% of patients with mild and moderate hypertension, diastolic pressure values less than 95 mmHg were obtained in monotherapy with a betablocker. The incidence of undesirable effects was low, the drug was tolerated well. Biochemical parameters did not change within the three months of study.