Treating tachyarrhythmias with radiofrequency catheter ablation.

Fast, safe, and effective, radiofrequency catheter ablation is becoming more common as a treatment for tachyarrhythmias. This article describes the procedure, which patients are eligible for it, and nursing considerations before, during, and after the procedure.

Wall stress-induced dysrhythmias in the isolated working rat heart perfused through a cannula placed in the left ventricle via aorta.

The purpose of the present study was to determine if our recently introduced novel working rat heart preparation could be used to study wall stress-induced dysrhythmias. A double cannula, which consisted of an outer cannula that, was inserted in the aorta and an inner cannula that was advanced into the left ventricle was used. The perfusion flowed through the inner cannula into the left ventricle and was ejected from there into the aorta. Afterload was changed suddenly from 60 to 160 Hg of pressure by turning a valve so that the fluid was diverted to a column set at a different height. A sudden increase of aortic pressure that lasted for 10 sec caused cardiac ectopic beats. Wall stress-induced dysrhythmias were more sustained during perfusion with low potassium and low magnesium Krebs-Henseleit solution. Bradykinin (1 microg) or epinephrine (10 microg) was injected as a bolus via an in-line injection port placed at the inner cannula. Bradykinin significantly reduced the incidence of ectopic beats and epinephrine increased the incidence of nonsustained runs of VT. This "working" heart preparation is a convenient tool to study wall stress-induced dysrhythmias.

Cellular signals in atherosclerosis.

Atherosclerosis is a complex, incompletely understood process involving several cell types, including smooth muscle cells, endothelial cells, and platelets, and the signals between them. Atherosclerotic lesions result from an excessive inflammatory fibroproliferative response to various forms of insult to the endothelium and smooth muscle of the artery wall. Numerous growth regulatory molecules/factors participate in this process. This article reviews the atherosclerotic process and provides new scientific insights into the prevention and treatment of this disease. The implications for nursing are described.

Transcatheter ablation of tachyarrhythmias: an overview and case studies.

Transcatheter ablation techniques have recently been introduced as a treatment for patients with refractory tachyarrhythmias. These techniques include delivery of high energy direct-current (DC) or low energy radiofrequency (RF) current to permanently interrupt electrical conduction or activity in a region of arrhythmogenic cardiac tissue. Regardless of the technique, however, transcatheter ablation is a complex procedure that requires close collaboration of physicians and nurses in order to enhance the potential for achieving a successful outcome. Because cardiovascular nurses play a pivotal role in caring for a patient undergoing transcatheter ablation, this article presents the technique and the associated nursing care of two patients undergoing this treatment modality.

Hypertensive crisis: review and update.

The best treatment for a hypertensive crisis is prevention. Early identification and treatment of hypertension can prevent the development of most hypertensive crises. Although the increased emphasis on detection and advances in pharmacologic treatment of hypertension has influenced the decline in frequency of this disorder in recent years, critical care nurses still need to be aware of this potentially lethal complication of hypertension.

Gaining access to clinical sites and subjects for clinical research.

During the past few years, a significant number of articles have been written describing the research process in the clinical arena. Only a limited number of these articles, however, have addressed some of the obstacles encountered in clinical research. This article identifies and describes several strategies that may assist novice critical care nurse researchers in overcoming the obstacles of gaining access to clinical sites and subjects.

The cardiovascular effects of adenosine: clinical use and nursing implications.

Adenosine, an endogenous nucleoside, is involved in numerous biologic processes. An important regulator of cardiac rhythm and coronary blood flow, adenosine is useful in the diagnosis and treatment of PSVT. In addition, adenosine may soon be available for cardiac imaging and eventually as a protective agent against acute myocardial infarction and reperfusion injury. This article reviews the cardiovascular effects of adenosine, its diagnostic and therapeutic utility, and the implications for nursing care.

Nursing diagnoses for automatic implantable cardioverter defibrillator patients.

The automatic implantable cardioverter defibrillator (AICD) represents an exciting new technological advance in treating patients with recurrent malignant ventricular arrhythmias. The nursing care of patients undergoing this treatment modality requires early identification of nursing diagnoses so that appropriate interventions may be implemented.

Classification of cardiac pacemakers: the pacemaker code.

Pacemaker codes were developed to describe cardiac pacemaker function. Familiarity with these codes is essential for nurses caring for the patient with a permanent pacemaker. The article addresses the classification code of the North American Society of Pacing and Electrophysiology and the British Pacing and Electrophysiology Group and its relationship to pacemaker characteristics.

Transcutaneous pacemakers.

Transcutaneous pacing (TP) is technically the fastest, easiest, and least physically invasive of the accepted modes of cardiac pacing. Although first introduced in the early 1950s, TP was abandoned because of cutaneous nerve pain, skeletal muscle contraction, and local tissue burns associated with the use of the technique. The advent of transvenous pacing caused a further decline in interest in TP. Recent investigations suggest that this pacing mode has value when immediate pacemaker therapy is needed in the prehospital or hospital setting. As a result of the renewed interest in TP, the cardiovascular nurse should be aware of this therapy. The article presents a general overview of TP with emphasis on nursing care.

An algorithm for ventricular assist devices.

The use of ventricular assist devices (VADs) is becoming more common in cardiac surgery centers as the indications for application of these devices are expanding. Nurses caring for cardiovascular patients need to become familiar with the current clinical criteria used in VAD application. This author has developed an algorithm that is helpful in teaching VAD nursing care and evaluating cases in practice.

Patients with ventricular assist devices. Nursing diagnoses.

The nursing diagnoses relative to the patient with a ventricular assist device require collaborative and preventative interventions, and thus present a tremendous but rewarding challenge.

Life after sudden death: the development of a support group for automatic implantable cardioverter-defibrillator patients.

Sudden cardiac death is one of the major public health problems in the United States today. Although the implementation of the automatic implantable cardioverter-defibrillator has been shown to improve the survival in patients resuscitated after sudden cardiac death, it has also resulted in a new clinical population with unique psychosocial needs. A support group may assist cardiovascular nurses in meeting these psychosocial needs. This article describes the experience in developing a support group for automatic implantable cardioverter-defibrillator recipients and their families in one medical center.

Cryoablation for refractory ventricular dysrhythmias.

Several of the surgical ablative techniques currently used to treat patients with medically refractory ventricular dysrhythmias are performed in combination with cryosurgery. By inducing hypothermic injury, cryosurgery destroys the muscle responsible for the ventricular ectopy without disrupting the structural integrity of the heart. The use of this procedure in treating these patients, however, without adjunctive surgical techniques is uncommon. This case study describes the successful use of cryosurgery without concomitant surgical ablative techniques.