ABSTRACT
The aim of this study was to assess to what extent patients with VVIR pacemakers and without overt symptoms of a pacemaker syndrome benefit from a pacemaker upgrade, and if a preoperative noninvasive measurement of the change in stroke volume (SV) could predict the effect of a pacemaker upgrade. The study group consisted of 20 (12 women, 8 men) VVIR patients with a mean age of 60 years. The indication for the first implantation was AV block in 13 patients and SSS in 7. The mean time of a ventricular pacing was 77 months. The objective (echocardiography, an exercise capacity) and the subjective (the quality-of-life) parameters investigated in patients during ventricular pacing were compared to results obtained 2 months and 1 year after a pacemaker upgrade. To assess preoperatively a change in a SV expected after upgrading, attempts were made to restore AV synchronization by the use of a transesophageal pacemaker. An increase in SV (from 5% to > 35%) during temporary AV resynchronization was observed in each patient. Values of SV increase correlated with those obtained 2 months (r = 0.65; P < 0.01) and 1 year (r = 0.66; P < 0.01) after an upgrade. Superior hemodynamics was associated with a significant improvement of an exercise capacity in both subgroups of patients. The most significant improvement in the quality-of-life was observed in patients with SSS. We did not find correlations between SV and the quality-of-life assessed 2 months (r = 0.043; NS) or 1 year (r = 0.02; NS) after an upgrade. In conclusion, a pacemaker upgrade performed after a long-term ventricular pacing resulted almost consistently in the improvement of hemodynamics and was associated with an increase of exercise capacity. In patients with SSS it was followed by the significant improvement of their quality-of-life. Such a relation was not observed in patients with AV block as some of them (especially those with VVIR pacemakers) felt quite well during ventricular pacing. The proposed preoperative echocardiographic evaluation may precisely predict the degree of hemodynamic improvement expected after a pacemaker upgrade.
Subject(s)
Cardiac Pacing, Artificial/methods , Cardiac Pacing, Artificial/psychology , Physical Endurance/physiology , Quality of Life , Stroke Volume/physiology , Adult , Aged , Aged, 80 and over , Analysis of Variance , Echocardiography , Exercise Test , Female , Heart Block/psychology , Heart Block/therapy , Hemodynamics , Humans , Male , Middle AgedABSTRACT
Kawasaki syndrome is an acute multisystem vasculitis of infancy and early childhood associated with high fever, mucocutaneous inflammation, and the development of coronary artery abnormalities. We describe the clinical evaluation and treatment with intravenously administered immune globulin in two children with Kawasaki syndrome.
Subject(s)
Immunoglobulins, Intravenous/therapeutic use , Mucocutaneous Lymph Node Syndrome/therapy , Child, Preschool , Humans , Male , Mucocutaneous Lymph Node Syndrome/diagnosisABSTRACT
The effect of mental stress was demonstrated on the development of arrhythmias in patients after acute myocardial infarction. During 24-hour Holter's monitoring (3 weeks after infarction onset) a stressful psychological experiment (free association test) was carried out on the patients observing their reactions during the experiment, and heart action during and after it. During the experiment changes were observed in heart action such as increased heart rate, appearance or intensification of quantitative and qualitative ventricular arrhythmias. The authors discuss the relationship between mental stress and the development of arrhythmias.
