Glucose-insulin-potassium echocardiography detects improved segmental myocardial function and viable tissue shortly after acute myocardial infarction.

Previous studies showed that glucose-insulin-potassium (GIK) increases cardiac output in patients after cardiac surgery and improves segmental myocardial wall motion. We hypothesized that GIK improves regional wall motion, detects contractile reserve, and predicts functional recovery at follow-up to a similar extent as low-dose dobutamine (LDD) in patients with recent myocardial infarction. Forty-one patients underwent LDD and GIK echocardiography. Data were analyzed according to a 13-segment model. Segments were scored from 0 (normokinesia) to 2 (a-/dyskinesia). Wall motion score index was calculated for baseline and intervention. During GIK, wall motion score index improved from 0.60 +/- 0.25 to 0.39 +/- 0.20 (P < .0001) and from 0.58 +/- 0.25 to 0.39 +/- 0.21 (P < .0001) during LDD. Overall agreement between GIK and LDD echocardiography to detect contractile reserve (improvement of segmental function by >or= 1 point) was 93% with a kappa value of 0.88. Sensitivity, specificity, and positive and negative predictive values of GIK echocardiography to predict functional recovery at follow-up (mean time to follow-up, 13 months) were 74%, 84%, 85%, and 72% respectively, and values were similar to LDD echocardiography. Thus, GIK infusion improves regional left ventricular function and allows the detection of myocardial viability to a similar extent as LDD in patients shortly after infarction.

Usefulness of a new active-fixation lead in transvenous temporary pacing from the femoral approach.

Temporary transvenous pacing is associated with a high incidence of complications with a substantial dislocation rate reported to occur in more than one-third of patients. This article describes a novel 3.5 Fr temporary pacing lead using active fixation in a consecutive series of 42 patients with prolonged (> or = 48 hours) temporary pacing. The dislocation rate was 4.8%, while in 7.1% of patients inappropriate pacing (more than a twofold increase of initial pacing threshold) was observed. The total procedural related complication rate (dislocation, inappropriate pacing, local infection, and/or thrombosis) was 31% during a mean duration of pacing of 5.96 +/- 2.6 days. Ambulatory pacing was performed in the vast majority (74%) of patients. Temporary transvenous pacing using an active-fixation lead is safe and permits long-term ambulatory pacing with a low dislocation rate.

The effect of rate responsive pacing in patients with angina pectoris on the extent of ischemia on 201-thallium exercise scintigraphy.

In patients with coronary artery disease (CAD), rate responsive pacing is considered to be contraindicated because an increase in heart rate may increase oxygen demand. Although previous studies have shown no subjective increase in ischemia during rate responsive pacing, data from objective assessment have not been documented. The goal of this study was to determine if there was an increase in ischemia on 201-Thallium (201 Tl) exercise scintigraphy in this mode of pacing in patients with CAD and angina. Eighteen consecutive patients with chronic atrial fibrillation and symptomatic bradyarrhythmias with a pacemaker for more than 6 months participated in the study. In VVI and VVIR modes a symptom-limited exercise 201 Tl scintigram was performed in a single blind randomized crossover fashion. Exercise duration, anginal attacks, use of nitroglycerine (NTG) tablets, blood pressure, and analysis of the scintigrams were assessed during each pacing mode. Fifteen men and three women were included (age 65.9 +/- 4.9 years, LVEF 0.44 +/- 0.07). Four were in Class III angina pectoris, and 14 in class II. The mean exercise duration increased 28% in the VVIR group without an increase in anginal attacks per week or the use of NTG tablets. On scintigrams, no differences were seen between the two groups. One patient was withdrawn from the study because of an increase in angina pectoris (AP) attacks during VVIR pacing. Rate responsive pacing is safe and effective in patients with CAD without an increase in subjective and objective signs of ischemia.