[Current use and outcomes of intraaortic balloon counterpulsation in routine cardiology]. / Aktueller Einsatz und Stellenwert der intraaortalen Ballongegenpulsation in der kardiologischen Routine.

BACKGROUND: Intraaortic balloon counterpulsation (IABC) is an established technique for temporary support of the left ventricular function. However, less is known about the current use and outcome of IABC in daily clinical practice. PATIENTS AND METHOD: From July 1995 to May 1999 all patients receiving an IABC in the Department of Cardiology of the Heart Center Ludwigshafen were included in a consecutive registry and follow-up data were obtained. RESULTS: Sixty-six patients (mean age 65 years, 64% male) received an IABC during the registration period. In 95% of cases the indication for IABC was the presence of cardiogenic shock. The shock was due to an acute myocardial infarction in 83%, other reasons were less frequent (< or = 5%). Total inhospital mortality was 48%. Patients in shock due to myocardial infarction (53%) showed the highest mortality. During follow-up (median 20 months) another 21% died. Complications occurred in 20% of patients under IABC, including vascular complications in 12%, infections in 5% and major bleedings in 3%. There was no difference between mortality among patients with complications and total mortality. CONCLUSION: Main indication for IABC in daily practice is the presence of cardiogenic shock (95%), dominantly due to myocardial infarction (83%). Despite IABC therapy, half of these patients die during the hospital stay. High mortality of cardiogenic shock in myocardial infarction with pharmacological therapy justifies IABC treatment with regard to a rate of complications of 20%.

Intraindividual comparison of diltiazem and verapamil on induction of paroxysmal supraventricular tachycardia.

The effects of i.v. diltiazem (0.25 mg/kg) and i.v. verapamil (0.15 mg/kg) were studied in 18 patients with recurrent paroxysmal supraventricular tachycardia (SVT) who underwent serial electrophysiological studies. In 10 of 18 patients with extranodal accessory pathways the effects of diltiazem and verapamil were similar in comparable plasma concentrations. SVT was prevented in 10/10 cases after diltiazem and 9/10 cases after verapamil, furthermore there as an increase in antegrade refractoriness of the normal AV nodal pathway of 22 and 27%, respectively; accessory pathway refractoriness and conduction remained unchanged in both drugs. In 8 of 18 patients with dual AV nodal pathways diltiazem was significantly less effective as compared to verapamil (p < 0.02) regarding prevention ov SVT (3/8 vs. 8/8 cases) and increase in the antegrade refractoriness of the slow AV nodal pathway (+21 vs. +34%). However, both drugs produced equivalent slowing of antegrade AV nodal conduction and a similar increase in antegrade refractoriness of the fast AV nodal pathway. In all 18 patients, the site of action of both drugs was the antegrade limb, regardless of SVT mechanism. The data suggest that the two calcium antagonists are equipotent in AV reentrance but verapamil may offer greater benefit in AV nodal reentrance than diltiazem.