bluuebunny/crossref_metadata_2025 huggingface dataset:
Obesity and associated modifiable environmental factors in Iranian adolescents: Isfahan Healthy Heart Program − Heart Health Promotion from Childhood
Authors: Kelishadi RoYA , Hashemi Pour M , Sarraf‐Zadegan N , Sadry GHOLAM hOSSEIN , Ansari REZVAN , Alikhassy H , Bashardoust NASROLLAH
Published: December 2004

Objective
: To evaluate the prevalence of overweight and obesity among Iranian adolescents and their relationship with modifiable environmental factors.

Methods
: The subjects of the present study were 1000 girls and 1000 boys, aged between 11 and 18 years selected by multistage random sampling, their parents (n = 2000) and their school staff (n = 500 subjects) in urban and rural areas of two provinces in Iran. Data concerning body mass index (BMI), nutrition and the physical activity of the subjects were analyzed by SPSSV10/Win software.

Results
: The prevalence of 85th percentile ≤ body mass index (BMI) < 95th percentile and BMI > 95th percentile in girls was significantly higher than boys (10.7 ± 1.1 and 2.9 ± 0.1%vs 7.4 ± 0.9 and 1.9 ± 0.1%, respectively; P < 0.05). The mean BMI value was significantly different between urban and rural areas (25.4 ± 5.2 vs 23.2 ± 7.1 kg/m2, respectively; P < 0.05). A BMI> 85th percentile was more prevalent in families with an average income than in high‐income families (9.3 ± 1.7 vs 7.2 ± 1.4%, respectively; P < 0.05) and in those with lower‐educated mothers (9.2 ± 2.1 vs 11.5 ± 2.4 years of mothers education, respectively). The mean total energy intake was not different between overweight or obese and normal‐weight subjects (1825 ± 90 vs 1815 ± 85 kCal, respectively; P > 0.05), but the percentage of energy derived from carbo­hydrates was significantly higher in the former group compared with the latter (69.4 vs 63.2%, respectively; P < 0.05). Regular extracurricular sports activities were significantly lower and the time spent watching tele­vision was significantly higher in overweight or obese than non‐obese subjects (time spent watching telelvision: 300 ± 20 vs 240 ± 30 min/day, P < 0.05). A significant linear association was shown between the frequency of consumption of rice, bread, pasta, fast foods and fat/salty snacks and BMI (β = 0.05−0.06; P < 0.05). A significant correlation was shown between BMI percentiles and serum triglyceride, high‐density lipoprotein−cholesterol and systolic blood pressure (Pearson's r = 0.38, −0.32 and 0.47, respectively).

Conclusions
: Enhanced efforts to prevent and control overweight from childhood is a critical national priority, even in developing countries. To be successful, social, cultural and economic influences should be considered.
Association between household conditions and diarrheal diseases among children in Turkey: A cohort study
Authors: Bozkurt Ali İhsan , Özgür Servet , Özçİrpİcİ Birgül
Published: December 2004

Background
: This aim of the present study was to estimate the frequency of diarrheal diseases among children as well as investigating the relationship between diarrheal diseases and household conditions and other factors.

Methods
: The study was performed over 12 month period in Binevler Health Center, Gaziantep, Turkey. Five health stations were selected by using a sampling technique with probability proportional to size, and all households with children under the age of 5 years were visited. A questionnaire on diarrhea, household conditions, socioeconomic status of the family and individual characteristics of the children was applied to the mothers by doctors. Three composite indices, including household conditions, socioeconomic status of the family and individual status of the children, were prepared and a classification was made as good, mild or poor in order to better evaluate the results of the study. Daily recordings of diarrheal disease symptoms were made by the parents and these records were collected every month for 1 year.

Results
: The annual mean incidence of diarrheal diseases was found to be 1.09 per child per year (median = 1). The mean was higher in children with poor household conditions (1.48 ± 0.12) and with poor individual status (1.48 ± 0.14), compared with good household conditions (0.76 ± 0.07) and good individual status (0.71 ± 0.08). The mean was also higher in children aged between 6 and 11 months (1.51 ± 0.18), whose father graduated from primary school or lower (1.34 ± 0.09) and with parents having no habit of washing their hands before taking care of the child (2.00 ± 0.33). Person−month and case−month incidence rates of diarrhea were calculated to be 8.56 and 9.12%, respectively.

Conclusions
: Household conditions, individual status, age, education level of fathers and parents’ habit of washing hands before taking care of the child were major factors affecting the incidence of diarrhea.
Neonatal clinical outcome after electivecesarean section before the onset of labor at the 37th and 38thweek of gestation
Authors: Yamazaki Hajime , Torigoe Katsumi , Numata Osamu , Nagai Sakiko , Haniu Hisanori , Uchiyama Asami , Ogawa Youhei , Imamura Masaru , Hasegawa Satoshi
Published: December 2004

Background
: Although elective cesareansections are often performed after the 37th week of gestation withoutany complicating factor that may influence the timing of delivery,there is a possibility that infants born in the 37th week of gestation,especially early in the 37th week of gestation, do not obtain asatisfactory clinical outcome due to premature birth.

Methods
: The authors analyzed the clinicalcourse during the neonatal period in 96 infants born in the 37th (n = 81)and 38th (n = 15) week of gestationby an elective cesarean section. Subjects were retrospectively dividedinto two groups: infants born in the first half of the 37th weekof gestation (37+0−37+3)(n = 48), and infants born fromthe latter half of the 37th week of gestation (37+4−37+6)through the 38th week of gestation (n = 48).Twin pregnancies, pregnancy with placenta previa, and pregnancyof women who had a diversity of medical complications were excludedfrom the present study, because of the possibility that these conditions mayhave affected the infants’ status. The incidence of infantswho showed clinical symptoms during the neonatal period and whoneeded medical care was compared between the two groups.

Results
: Of the 96 subjects, 25 infants(26.0%) had significant clinical symptoms. The incidenceof breathing difficulty was significantly higher in the infant groupborn in the first half of the 37th week of gestation than in thelatter group.

Conclusions
: An elective cesarean sectionbefore the onset of labor early in the 37th week of gestation should notbe routinely undertaken.
Feeding practice of infants and their correlates in urban areas of Beijing, China
Authors: Li Liubai , Li Sujun , Ali Moazzam , Ushijima Hiroshi
Published: December 2004

Background
: Optimal feeding practice in the first year of life is crucial for the survival and health of infants, and has long‐term consequences in later life. However, non‐optimal feeding practices exist widely. The present study aims to explore various constraints to optimal feeding practices in the first year of life of infants in urban areas of Beijing, China.

Methods
: A cross‐sectional study was conducted in urban areas of Beijing from 4 July to 20 August, 1998. Two hundred and fifty‐one mothers of infants aged 6−12 months were chosen from six child health centers in three different urban districts in Beijing. A self‐administered structured questionnaire was used to collect data regarding feeding practices and potentially related factors.

Results
: Feeding practice for most of the infants was in accordance with the national and international recommendations. However, the rate of incidence of exclusive breast‐feeding at 3 months of age was lower than that recommended by the World Health Organisation (WHO) (55.8%), and the introduction of solid/semisolid food before 4 months of age was found in approximately 19.3% of the infants. Cow's milk was given to 21.2% of infants from 6 months of age as the sole source of milk or as a supplement. Maternal education level (OR = 2.44, 95% CI: 1.42−4.19, P < 0.05), employment (OR = 2.05, 95% CI: 1.13−3.74, P < 0.05) and antenatal nonexclusive breast‐feeding plans (OR = 4.10, 95% CI: 2.24−7.50, P < 0.001) were found to be correlated to inappropriate feeding practices.

Conclusions
: The feeding practices for most of the urban infants was found to be in accordance with the Chinese government and WHO recommendations; however, non‐optimal feeding practices presenting as the early cessation of breast‐feeding and the introduction of solid/semisolid foods existed. Information regarding optimal feeding practices should be disseminated to mothers and medical professionals in China, to ensure optimal infant health.
Application of transvaginal hydrolaparoscopy for ovarian drilling using Nd:YAG laser in infertile women with polycystic ovary syndrome
Authors: Hirano Yuki , Shibahara Hiroaki , Takamizawa Satoru , Suzuki Izumi , Yamanaka Seiji , Suzuki Tatsuya , Fujiwara Hiroyuki , Suzuki Mitsuaki
Published: December 2004

Since transvaginal hydrolaparoscopy (THL) was introduced as the first‐line procedure in the early stage of the exploration of the tubo‐ovarian structures in infertile women, it has been shown that THL is a less traumatic and a more suitable outpatient procedure than diagnostic laparoscopy. In the present study, a minimally invasive surgery was carried out in infertile women with polycystic ovary syndrome (PCOS) by THL. Ovarian drilling using Nd:YAG laser vaporization by THL was performed in two clomiphen citrate‐resistant infertile women with PCOS. After ovarian drilling with THL, a patient recovered an ovulatory cycle. These findings suggest that ovarian drilling by THL seems to be a safe procedure in infertile women with PCOS. However, further investigations are required to evaluate the effectiveness and risks of this minimally invasive operation. (Reprod Med Biol 2003; 2: 37–40)
Beneficial Effects of Biventricular Pacing in Patients with a “Narrow” QRS
Authors: GASPARINI MAURIZIO , MANTICA MASSIMO , GALIMBERTI PAOLA , MARCONI MANUEL , GENOVESE LUCA , FALETRA FRANCESCO , SIMONINI STEFANO , KLERSY CATHERINE , COATES ROBERT , GRONDA EDOARDO
Published: December 2004

GASPARINI, M., et al.: Beneficial Effects of Biventricular Pacing in Patients with a “Narrow” QRS.
Congestive heart failure (CHF) patients with LBBB and QRS duration >150 ms are considered the best candidates to biventricular pacing (Biv‐P). However, patients with a narrow (120–150 ms) QRS may also benefit from Biv‐P since true ventricular dyssynchrony may be underestimated by considering only QRS enlargement. From October 1999 to April 2002, 158 CHF patients (121 men, mean age 65 years, mean LVEF 0.29, mean QRS width 174 ms) underwent successful Biv‐P implantation and were then followed for a mean time of 11.2 months. According to basal QRS duration, patients were divided in two groups, with wide QRS (≥150 ms, 128 patients, 81%) and with narrow QRS (<150 ms, 30 patients, 19%). In the wide QRS group, LVEF improved from 29% to 39% (P < 0.0001), 6‐minute walk test from 311 to 463 m (P < 0.0001), while NYHA Class III–IV patients decreased from 86% to 8% (P < 0.0001). In the narrow QRS group LVEF improved from 30% to 38% (P < 0.0001), 6‐minute walk test from 370 to 506 m (P < 0.0001), and NYHA Class III–IV patients decreased from 60% to 0% (P < 0.0001). The data showed that in wide and narrow QRS patients, Biv‐P significantly improved clinical parameters (NYHA class, 6‐minute walk test, quality‐of‐life, and hospitalization rate) and main echocardiographic indicators. Furthermore, narrow QRS patients had a better survival rate, rapidly regained left ventricular function, and only a few patients remained in a higher NYHA class during follow‐up. These patients should not be excluded “a priori” from cardiac resynchronization therapy. (PACE 2003; 26[Pt. II]:169–174)
Is the Outcome of Cardiac Resynchronization Therapy Related to the Underlying Etiology?
Authors: GASPARINI MAURIZIO , MANTICA MASSIMO , GALIMBERTI PAOLA , GENOVESE LUCA , PINI DANIELA , FALETRA FRANCESCO , LA MARCHESINA UGO , MANGIAVACCHI MAURIZIO , KLERSY CATHERINE , GRONDA EDOARDO
Published: December 2004

GASPARINI, M., et al.: Is the Outcome of Cardiac Resynchronization Therapy Related to the Underlying Etiology?
This study was designed to examine the importance of the underlying cardiac pathology on outcome of cardiac resynchronization therapy (CRT), hypothesizing that myocardial infarction scar and other noncontractile segments represent limitations to the ability to resynchronize cardiac contraction in patients with congestive heart failure associated with dilated cardiomyopathy. From October 1999 to April 2002, 158 patients (mean age 65 years, 121 men) were included in a single center, longitudinal, comparative study. All patients had dilated cardiomyopathy and indications for CRT with a mean QRS duration of 174 ms. The patient population was divided into a coronary artery disease (CAD) group that included patients with significant CAD, and no indication, or a contraindication for revascularization, and a non‐CAD group that included patients with nonischemic dilated cardiomypopathy. Follow‐up data were collected at 3, 6, and 12 months, and yearly thereafter. The median follow‐up was 11.2 months. In the CAD group, the LVEF increased from 0.29 to

0.34 (P < 0.0001)

, the 6‐minute walk test distance increased from 310 to

463 m (P < 0.0001)

, and the percentage of patients in NYHA functional Class III–IV decreased from 83% to

23% (P = 0.04)

. In the non‐CAD group, LVEF increased from 29% to 42% (P < 0.0001), the 6‐minute walk test distance increased from 332 to 471 m

(P < 0.0001)

, and the percentage of patients in NYHA functional Class III–IV decreased from 79% to

5%, (P < 0.0001)

. Comparison of the two groups showed that patients in the non‐CAD group had a significantly greater increase in

LVEF (P = 0.007)

and decrease in NYHA class

(P < 0.05)

. Patients with CAD or non‐CAD significantly improved clinically during CRT. Non‐CAD patients had a greater increase in LVEF and decrease in NYHA functional class than patients with CAD. (PACE 2003; 26[Pt. II]:175–180)
Thromboembolic Risk of Patients Referred for Radiofrequency Catheter Ablation of Typical Atrial Flutter Without Prior Appropriate Anticoagulation Therapy
Authors: GRÖNEFELD GERIAN C. , WEGENER FLORIAN , ISRAEL CARSTEN W. , TEUPE CLAUDIUS , HOHNLOSER STEFAN H.
Published: December 2004

GRÖNEFELD, G.C., et al.: Thromboembolic Risk of Patients Referred for Radiofrequency Catheter Ablation of Typical Atrial Flutter Without Appropriate Prior Anticoagulation Therapy.
Background: Radiofrequency catheter ablation of isthmus dependent atrial flutter is considered the therapy of choice. There is, however, controversy with regard to the thrombogenicity of atrial flutter in comparison with atrial fibrillation. Methods: Consecutive patients scheduled for catheter ablation of documented typical atrial flutter receiving insufficient (INR < 2.0) or no anticoagulation during the three weeks preceding the procedure underwent multiplane transesophageal echocardiography (TEE). Patients with exclusive documentation of atrial flutter were classified as group I, whereas patients with additional documentation of atrial fibrillation were classified as group II. Results: The study included 201 patients, 62 of whom were not on therapeutic anticoagulation (mean age

64 ± 9

years, 87% men). In 10 of these 62 patients (16%), TEE detected a left atrial (LA) appendage thrombus in 4, or dense spontaneous echo contrast (SEC) in 6 patients. Comparison of patients with versus without SEC or thrombus, revealed a higher incidence of valvular heart disease (60% vs 26%,

P = 0.05

), but no differences with respect to age, gender, LA diameter, left ventricular end‐diastolic diameter, or left ventricular ejection fraction. The incidence of positive TEE findings in group I was 1 in of 36 versus 9 of 26 in group II (3% vs 35%, P < 0.001), and the relative risk for thromboembolism in group II versus group I was 12.5 (95% CI: 3‐55, P < 0.001). Conclusion: There is a significant risk for thromboembolism in patients referred for ablation of typical atrial flutter who have not been appropriately anticoagulated. (PACE 2003; 26[Pt. II]:323–327)
Implantation of Pacemakers and Implantable Cardioverter Defibrillators in Orally Anticoagulated Patients
Authors: AL‐KHADRA AYMAN S.
Published: December 2004

AL‐KHADRA, A.S.: Implantation of Pacemakers and Implantable Cardioverter Defibrillators in Orally Anticoagulated Patients.
The safety of pacemaker and defibrillator implantations in orally anticoagulated patients using standard techniques has not been thoroughly evaluated. This article describes a prospectively collected experience in such patients. Patients presenting for device implantation who were treated with warfarin were allowed to continue therapy provided that the INR was <3.5. Implantations involved cannulation of the left axillary vein. Except for defibrillator leads, 7 Fr introducers were used, and all were leads actively fixated. The study included 47 patients who underwent implantation of permanent pacemakers (n = 39), defibrillators (n = 5), or biventricular pacemakers (n = 3). The mean INR was 2.3. The primary indication for anticoagulation was a mechanical cardiac prosthesis in 11 (24%) patients. Atrial fibrillation was present in 33 patients. There were no instances of major bleeding or hematomas requiring evacuation. One patient had a small soft hematoma, which resolved spontaneously. At 6 weeks, all patients had well‐healed scars with satisfactory pacing and sensing thresholds. In experienced centers, patients requiring treatment with warfarin may undergo implantation of pacemakers or defibrillators with minimal risk despite continuation of anticoagulation. (PACE 2003; 26[Pt. II]:511–514)
Broad Applicability of Ultrarapid Train Stimulation as an Efficient Alternative to Conventional Programmed Electrical Stimulation
Authors: FISHER JOHN D. , PLATT SIMIE B. , CUA MARK C. , WASPE LAWRENCE E. , KIM SOO G. , FERRICK KEVIN J. , GROSS JAY N. , ROTH JAMES A.
Published: December 2004

FISHER, J.D.,

et al.:

Broad Applicability of Ultrarapid Train Stimulation as an Efficient Alternative to Conventional Programmed Electrical Stimulation.
Background and study objective:Conventional programmed electrical stimulation (PES) is useful for establishing inducibility or noninducibility of clinical ventricular arrhythmias (VA), but is complex and time‐consuming. This study compared a standard PES protocol with ultrarapid train stimulation (UTS) in a broad range of patients with and without a history of ventricular arrhythmias or structural heart disease. Methods: Patients prospectively underwent electrophysiologic testing with both UTS and conventional PES protocols in a randomized, crossover design. Results: The results were concordant in 79% of 150 matched pairs of comparisons in 104 patients (NS). There were no differences related to underlying heart disease or arrhythmia, or antiarrhythmic treatment. Induction of nonclinical arrhythmias with the two methods was similar

(P = 0.524)

. Inhibition phenomena were minor except in some patients receiving amiodarone. Fewer drive‐extrastimuli sequences and less time were needed to complete the trains protocol

(P < 0.0001)

. Conclusions: In cases where the main intent is to induce ventricular arrhythmias, UTS yields results that are similar to those of conventional PES protocols in a shorter length of time. (PACE 2003; 26[Pt. II]:518–523)
Comparison Between Biventricular Pacing and Single Site Pacing in Patients with Poor Ventricular Function:
Authors: VARMA C. , O'CALLAGHAN P. , ROWLAND E. , MAHON N.G. , MCKENNA W. , CAMM A.J. , BRECKER S.J.D.
Published: December 2004

VARMA, C., et al.: Comparison Between Biventricular Pacing and Single Site Pacing in Patients with Poor Ventricular Function: A Hemodynamic Study.
Biventricular pacing has been suggested as offering greater hemodynamic benefit than single site pacing in patients with advanced heart failure and left bundle branch block. This was tested using acute multisite pacing. Eighteen such patients were atrial‐sensed, ventricular multisite paced in random order for 5 minutes. The best achieved measure of cardiac output (CO), pulmonary capillary wedge pressure (PCWP) and left ventricular (LV) + dP/dtmax at RV, LV, and biventricular pacing sites compared. Baseline PCWP, CO, and LV + dP/dtmax were 20 ± 10 mmHg 4.8 ± 1.3 L/min and 680 ± 173 mmHg/s respectively. In all 18 patients CO and in 17 of 18 patients LV + dP/dtmax and PCWP improved with pacing. In the group as a whole, no significant hemodynamic difference between pacing sites was observed in PCWP (pacing site RV 19 ± 10 mmHg, LV 17 ± 10, biventricular 18 ± 11) or CO (RV 5.2 ± 1.5 L/min, LV 5.1 ± 1.5, biventricular 5.3 ± 1.7). Increased stroke volume/PCWP with LV (5.6 ± 3.7 mLs/mmHg) and biventricular pacing (

5.4 ± 4.0

) were not significantly greater compared to RV pacing (

4.7 ± 3.0

, ANOVA P = 0.20). Increase in LV + dP/dtmax with pacing at LV (814 ± 190 mmHg/s) and biventricular (

839 ± 290

) sites was not significantly greater than the increase with RV pacing (769 ± 203 mmHg/s, ANOVA P = 0.30). Pacing in patients with heart failure and conduction delay can produce a hemodynamic benefit. There is individual variation in the pacing site that leads to the greatest improvement. In the group as a whole, biventricular and LV pacing produced only modest improvements compared to RV pacing. (PACE 2003; 26[Pt. I]:551–558)
The Defibrillation Efficacy of High Frequency Alternating Current Sinusoidal Waveforms in Guinea Pigs
Authors: ROBERTS SCOTT J. , GUAN DONGXU , MALKIN ROBERT
Published: December 2004

ROBERTS, S.J., et al.: The Defibrillation Efficacy of High Frequency Alternating Current Sinusoidal Waveforms in Guinea Pigs.
There have been few basic studies of alternating current (AC) defibrillation, despite growing interest in the ability of AC to terminate or alter ongoing fibrillation. Based on fibrillation threshold testing, it has been suggested that cardiac tissue is most sensitive to long duration, low strength AC stimulation at around 50 Hz. This has not been directly tested for defibrillation. Two subcutaneous electrodes were placed 40 mm apart on opposing aspects of the guinea pig thorax. Seven seconds were allowed to elapse between fibrillation initiation and defibrillation. The tested waveforms were at 50, 100, 200, 500, and 1000 Hz with 2, 4, 8, 16, and 32‐cycles. The efficacy of every waveform was measured using a single stimulus in a large population of animals. Forty‐one guinea pigs were used in the fixed energy group. Thirty‐three guinea pigs were used in the fixed amplitude group with additional 1‐cycle waveforms tested. The 200‐Hz and the 2‐cycle waveforms were significantly more efficacious than those at other frequencies

(P < 0.02)

and other durations

(P < 0.001)
. The 50‐Hz waveforms were the least successful. Amplitude, not duration or energy, was the determinate of efficacy for 2‐cycle (the most efficacious) waveforms. Unlike low strength stimulation, defibrillation strength stimuli are most effective with high frequency (200 Hz) pulses (2 cycles). (PACE 2003; 26[Pt. I]:599–604)
A Case of a Short‐Coupled Variant of Torsades De Pointes with Electrical Storm
Authors: TAKEUCHI TOSHIHARU , SATO NOBUYUKI , KAWAMURA YUICHIRO , TAKAHASHI FUMIHIKO , SATO MOTOHIKO , KIKUCHI KENJIRO , AKASAKA NOBUYUKI , GO KAZUTOMO , FUJIMOTO KAZUHIRO , HASEBE NAOYUKI
Published: December 2004

TAKEUCHI, T., et al.: A Case of a Short‐Coupled Variant of Torsades De Pointes with Electrical Storm.
This case report describes a short‐coupled variant of Torsades de Pointes with a characteristic ECG pattern consisting of a prominent J wave in leads V3–V6, in which an electrical storm was evoked with autonomic receptor stimulation and a blockade test. The patient's frequent VF attacks were triggered by short‐coupled premature ventricular contractions with a right bundle branch block morphology and left‐axis deviation, and were suppressed by deep sedation followed by a combination therapy using verapamil and mexiletine. Interestingly, with the use of those drugs, the prominent J wave diminished. The mechanism underlying this syndrome is discussed. (PACE 2003; 26[Pt. I]:632–636)
Determinants of Persistent Atrial Fibrillation in Patients with DDD Pacemaker Implantation
Authors: DEMIR AHMET DURAN , SOYLU MUSTAFA , ÖZDEMIR ÖZCAN , BALBAY YÜCEL , TOPALOĞLU SERKAN , ŞAŞMAZ ALI , KORKMAZ ŞULE
Published: December 2004

DEMIR, A.D., et al.: Determinants of Persistent Atrial Fibrillation in Patients with DDD Pacemaker Implantation.
Occurrence of AF in a pacemaker implanted patient is a significant cause of morbidity and mortality. The aim of this study was to prospectively investigate the clinical, echocardiographic, and electrocardiographic determinants of persistent AF in patients with DDD pacemakers. A 101 consecutive patients were followed for an average of

19.8 ± 11.8

months. Persistent AF was documented in 21 (20.8%) patients and 80 (79.2%) patients were in sinus or physiologically paced rhythm. In patients with persistent AF, previous AF attacks were observed more frequently

(P < 0.03)

and left atrial dimension was higher

(3.5 ± 0.6

vs

3.0 ± 0.5 cm, P < 0.001)
. Average P maximum and P wave dispersion (PWD) values calculated in a 12‐lead surface electrocardiogram were also found to be significantly higher in patients with persistent AF(P < 0.001). Cox regression analysis demonstrated that the presence of previous AF attacks(RR 8.95, P < 0.001), increased left atrial dimension(RR 2.1, P < 0.02), P maximum duration120 ms (RR 6.1, P < 0.001), and PWD 40 ms(RR 12.2, P < 0.001)were associated with an increased risk of persistent AF. Cut‐off points were 120 ms for P maximum and 40 ms for PWD. Sensitivity, specificity, and positive and negative predictive values were calculated as 76.2, 82.5, 53.3, and 92.9 for P maximum and as 85.7, 87.5, 64.3, and 95.9 for PWD, respectively. In patients with DDD pacemakers, previous AF attacks, increased left atrial dimension, P maximum value of 120 ms, and a PWD value of 40 ms were associated with a significantly increased risk of persistent AF. These patients must further be managed with other treatment modalities to prevent the development of persistent AF. (PACE 2003; 26:719–724)
Tissue Temperature‐Controlled Radiofrequency Ablation
Authors: EICK OLAF J. , BIERBAUM DIRK
Published: December 2004

EICK, O.J., et al.: Tissue Temperature‐Controlled Radiofrequency Ablation.
During radiofrequency energy delivery, the catheter tip temperature can be significantly lower than the tissue temperature. The authors performed tissue temperature‐controlled radiofrequency ablation in vitro and evaluated the effects of cooling, electrode to tissue contact, and target tissue temperature on lesion size. Pieces of porcine ventricle were immersed in a bath of isotonic saline solution at 37°C. Radiofrequency energy was controlled by the tissue temperature as measured with a thermocouple needle placed 2 mm beneath the ablation electrode. Radiofrequency power was delivered for 30 seconds and limited to 50 W. A total of 81 radiofrequency ablations was performed with different electrode to tissue contact forces (0.04 N, 0.36 N, and 0.67 N) and target tissue temperatures (50°C, 60°C, and 70°C) using an irrigated (27 ablations, 20 mL/min irrigation flow rate) or a nonirrigated ablation catheter. Twenty‐seven nonirrigated applications were performed with fluid flow maintained by the pump of the thermostat and another 27 applications without flow. Every combination was applied three times and the average values were used for evaluation. For tissue target temperatures of 50°C, 60°C, and 70°C, the lesion volume for nonirrigated ablations was on average

21 ± 8 mm3, 45 ± 23 mm3
, and 109 ± 45 mm3, respectively, and for irrigated ablations12 ± 7 mm3, 37 ± 20 mm3, and92 ± 30 mm3, respectively. In both application groups the lesion size did not correlate with the electrode to tissue contact force. In the nonirrigated ablation group there was no difference in lesion size between the group with fluid flow and those without. Lesion size during tissue temperature‐controlled radiofrequency delivery increases with increasing target tissue temperature and becomes independent of flow and electrode to tissue contact. (PACE 2003; 26:725–730)
Alternatives When Coronary Sinus Pacing Is Not Possible
Authors: VLAY STEPHEN C.
Published: December 2004

VLAY, S.C.: Alternatives When Coronary Sinus Pacing Is Not Possible.
Biventricular pacing via a branch vein of the coronary sinus is not always possible due to anatomical reasons including phrenic nerve stimulation, scarred myocardium unable to sense or pace, and distorted anatomy prohibiting entry into the coronary sinus. Three patients are described in which alternative site pacing with an electrode in the right ventricular outflow tract alone or as a part of biventricular pacing system in the right ventricle provided a major improvement in dyspnea, congestive heart failure, New York Heart Association functional class, and ability to ambulate. (PACE 2003; 26[Pt. I]:4–7)
Atrial Septal Versus Atrial Appendage Pacing:
Authors: HERMIDA JEAN‐SYLVAIN , CARPENTIER CHRISTOPHE , KUBALA MACIEJ , OTMANI AKLI , DELONCA JEAN , JARRY GENEVIÈVE , REY JEAN‐LUC
Published: December 2004

HERMIDA, J.‐S., et al.: Atrial Septal Versus Atrial Appendage Pacing: Feasibility and Effects on Atrial Conduction, Interatrial Synchronization, and Atrioventricular Sequence.
Atrial septal (Se‐P) and atrial appendage pacing (Ap‐P) were compared in a randomized, controlled study to assess the feasibility, the reliability, and the effects of Se‐P on atrial conduction, interatrial synchronization, and the AV sequence. The main baseline characteristics of the patients were comparable in both groups. There was no difference in feasibility or reliability between the two techniques. Compared to Ap‐P

(n = 28)

, Se‐P

(n = 28)

decreased the P wave duration, left atrial electromechanical delay (LAEMD), and interatrial interval (−1.6% vs

+28%, P < 0.001; −3%

vs

+ 30%, P < 0.001; −130%

vs

+ 78%, P < 0.001

); it induced a smaller increase of the right AEMD, a slight reversal of the timing of the atrial systoles and a shortening of the PR interval (−13% vs

+ 25%, P < 0.001

) and of the interval separating atrial systoles from ventricular activation. Finally, the shortening of the PR interval was smaller during high Se‐P versus low Se‐P. Se‐P avoids the undesirable prolongation of the atrial, interatrial, and AV conductions observed during Ap‐P. In addition, Se‐P creates a slight reversal of the timing of the atrial systoles and induces a shortening of PR interval, the extent of which could depend on the height of the pacing site on the septum. (PACE 2003; 26[Pt. I]:26–35)
Long‐Term Outcome of Patients After Successful Radiofrequency Ablation for Typical Atrial Flutter
Authors: GILLIGAN DAVID M. , ZAKAIB JOHN S. , FULLER ITHIEL , SHEPARD RICHARD K. , DAN DAN , WOOD MARK A. , CLEMO HENRY F. , STAMBLER BRUCE S. , ELLENBOGEN KENNETH A.
Published: December 2004

GILLIGAN, D.M.,

et al

.: Long‐Term Outcome of Patients After Successful Radiofrequency Ablation for Typical Atrial Flutter.
The aim of the study was to determine the long‐term freedom from atrial arrhythmias after radiofrequency ablation of atrial flutter and to determine the factors associated with recurrent arrhythmias. Radiofrequency ablation has emerged as the preferred treatment for recurrent, typical atrial flutter. Although the short‐term results after radiofrequency ablation of atrial flutter have been widely reported, there is insufficient data on long‐term outcome with respect to the occurrence of atrial arrhythmias in patients after successful ablation. The first 108 patients to undergo successful ablation for typical atrial flutter at the authors' institutions were followed prospectively until the occurrence of typical atrial flutter, atrial fibrillation, atypical atrial flutter, or death. Several prespecified clinical and procedural factors were tested using univariate and multivariate analysis as predictors of arrhythmia recurrence. Patients were followed for a minimum of 3 years and a maximum of 8 years, or until the first arrhythmia recurrence (average duration 17 ± 17 months). Recurrences of typical atrial flutter were usually observed within the first 6 months (73%, n = 16), with the remainder (27%, n = 6) occurring between 6 months and 2 years, and none were observed later. Freedom from recurrence of typical atrial flutter was 80% at 1 year (95% CIs 72–89%), 73% at 2 years (CIs 63–83%), and 73% at 5 years (CIs 63–83%). By contrast, freedom from occurrence of atrial fibrillation or atypical atrial flutter progressively declined over time; 80% at 1 year (CIs 71–88%), 59% at 2 years (CIs 48–70%), and 33% at 5 years (CIs 19–48%). A history of atrial fibrillation or atypical atrial flutter prior to ablation was associated with an increased risk of occurrence during follow‐up (relative risk 3.4, CIs 1.5–8.1, P < 0.05). Freedom from occurrence of any atrial arrhythmia was only 27% at 5 years (CIs 15–40%). After successful ablation of typical atrial flutter, recurrence of typical flutter is relatively uncommon and usually occurs early. However, there is a progressive occurrence of atrial fibrillation and/or atypical flutter during follow‐up so that many patients require further antiarrhythmic or additional ablative therapy. Radiofrequency ablation of typical atrial flutter should be considered a palliative procedure for most patients and only one component of the long‐term care of the patient with atrial tachyarrhythmias. (PACE 2003; 26[Pt. I]:53–58)
Variability in Implantable Cardioverter Defibrillator Pulse Generator Longevity Between Manufacturers
Authors: ELLINOR PATRICK T. , GUY MARY L. , RUSKIN JEREMY N. , MCGOVERN BRIAN A.
Published: December 2004

ELLINOR, P.T., et al.: Variability in Implantable Cardioverter Defibrillator Pulse Generator Longevity Between Manufacturers.
ICDs are used frequently to treat malignant ventricular arrhythmias. Despite the expanding role of these devices, little is known about the manufacturer variability in the performance of ICD generators. The purpose of this study is to explore the indications for ICD pulse generator replacement and to examine performance differences between the three major manufacturers of ICDs in the United States. The authors performed a retrospective review of ICD pulse generators that were implanted and replaced at Massachusetts General Hospital between February 1998 and March 2002. During the study period, 50 (7%) of the 707 devices in the study cohort were replaced. The most common indication for pulse generator replacement was related to battery performance followed by device recall, upgrade to a dual chamber device, and pulse generator malfunction. After exclusion of the recalled devices, a significantly higher number of pulse generators manufactured by St. Jude Medical (14/229) required replacement for battery depletion or prolonged charge times during the study period compared with devices from Guidant (2/220) or Medtronic (0/273),
P = 0.003
and
P < 0.0001
, respectively. This difference was attributable to reduced longevity in the Angstrom series of defibrillators. (PACE 2003; 26[Pt. I]:71–75)
Perioperative anxiety and postoperative behavioural disturbances in children undergoing intravenous or inhalation induction of anaesthesia
Authors: Aguilera Isabel M. , Patel Davandra , Meakin George H. , Masterson Jerry
Published: December 2004

Summary Background: There are few published data comparing the psychological effects of intravenous (i.v.) and inhalation methods of anaesthesia induction in children. In the present study, we compared perioperative anxiety and postoperative behavioural changes in children undergoing standardized i.v. induction with thiopental and inhalation induction with sevoflurane for routine ear, nose and throat surgery.

Methods: Children were randomly assigned to receive inhalation induction with sevoflurane or i.v. induction with thiopental. Anxiety was assessed on arrival, at induction and 30 min after transfer to the recovery room using a four‐point scale. The incidence of postoperative behavioural disturbances was determined using a postoperative questionnaire.

Results: Significantly more children were anxious during induction in the i.v. group than in the inhalation group [23 of 50 (46%) versus 5 of 50 (10%); P = 0.0001]. Mean induction time was shorter (5.6 versus 7.0 min; P = 0.0001) and recovery time longer (30.5 versus 10.4 min; P = 0.0001) in the i.v. group compared with the inhalation group. Problematic behavioural changes were reported in the first 2 weeks after surgery in nine of 32 children (28%) in the i.v. group and 16 of 34 (48%) children in the inhalation group (P = 0.13).

Conclusions: Although children were more anxious during i.v. induction than inhalation induction, there was no difference in the incidence of behavioural disturbances in the first 2 weeks postoperatively.
Anaesthetic and airway management in a child with Hanhart's syndrome
Authors: Karakaya Deniz , Bari̇ş Sibel , Belet Nurşen , Güneren Ethem , Üstün Emre
Published: December 2004

Hanhart's syndrome (oromandibular‐limb hypogenesis syndrome) is a rare disease characterized by hypoglossia/aglossia, various distal limb defects and micrognathia. Difficult airway due to micrognathia may complicate anaesthetic management in this syndrome. We describe the anaesthetic management of a child with Hanhart's syndrome undergoing plastic reconstructive surgery.
Ketamine and midazolam is an inappropriate preinduction combination in uncooperative children undergoing brief ambulatory procedures
Authors: Verghese Susan T. , Hannallah Raafat S. , Patel Ramesh I. , Patel Kantilal M.
Published: December 2004

Summary Background: We prospectively studied the effects of intramuscular (i.m.) ketamine alone, or combined with midazolam, on mask acceptance and recovery in young children who were uncooperative during induction of anaesthesia.

Methods: The Institutional Review Board (IRB) approval was obtained to study 80 children, 1–3 years, scheduled for bilateral myringotomies and tube insertion (BMT). Mask induction was attempted in all the children. Those who were uncooperative were randomly assigned to one of the four preinduction treatment groups: group I, ketamine 2 mg·kg−1; group II, ketamine 2 mg·kg−1 combined with midazolam 0.1 mg·kg−1; group III, ketamine 2 mg·kg−1 with midazolam 0.2 mg·kg−1; or group IV, ketamine 1 mg·kg−1 with midazolam 0.2 mg·kg−1. Anaesthesia was continued with nitrous oxide and halothane by facemask.

Results: Children in all treatment groups achieved satisfactory sedation in less than 3 min following the administration of the preinduction drug(s). Compared with patients who received halothane induction (comparison group), the use of ketamine alone did not significantly (P > 0.0167, a Bonferroni corrected significance level) delay recovery and discharge times (18.8 ± 2.5 and 82.5 ± 30.7 min vs 12.6 ± 4.6 and 81.0 ± 33.8 min, P = 0.030 and P = 0.941, respectively). Patients who received ketamine/midazolam combinations, however, had significantly longer recovery and discharge times vs halothane (32.3 ± 14.0 and 128.0 ± 36.6 min, P = 0.001, P = 0.007, respectively). These times were so clinically unacceptable, that the study had to be terminated with only 17 patients receiving study drugs.

Conclusions: It is concluded that ketamine/midazolam combination is not appropriate for preinduction of anaesthesia in paediatric ambulatory patients because of unacceptably prolonged recovery and delayed discharge times.
A paediatric trial comparing midazolam/Syrpalta mixture with premixed midazolam syrup (Roche)
Authors: Khalil Samia N. , Vije H.N. , Kee S.S. , Farag Adel , Hanna Ehab , Chuang Alice Z.
Published: December 2004

Background: The bitter taste of midazolam is more acceptable to children when the drug is mixed with fruit juice or syrup. We use a thick grape syrup (Syrpalta), and children are sedated in 10–15 min. A premixed cherry‐flavoured midazolam solution (Roche), 2 mg·ml−1, is currently available. It has been our impression that the premixed midazolam has a slower onset of action. Our aim was to evaluate the effects of the midazolam mixtures (midazolam 0.5 mg·kg−1, 2 mg·ml−1) on children's anxiety, sedation, separation anxiety, mask acceptance, and recovery time.

Methods: Seventy‐six healthy children, 1–4 years of age, scheduled for elective placement of ear tubes, were enrolled. The trial was double‐blinded and randomized. For premedication, one group received the premixed midazolam, and a second group received the midazolam/Syrpalta mixture. An independent blinded observer evaluated the children, using anxiety and sedation scales at baseline, at 5, 10 and 15 min and at parental separation. Mask acceptance and awakening time were evaluated.

Results: Children who received the midazolam/Syrpalta mixture had less anxiety at 15 min (P = 0.046) and at parental separation (P < 0.001) than those who received the premixed midazolam solution. Mask acceptance was not different.

Conclusions: We concluded that the midazolam/Syrpalta mixture has a faster onset of action than the premixed midazolam solution.
Depth of consciousness and deep sedation attained in children as administered by nonanaesthesiologists in a children's hospital
Authors: Motas Dominika , McDermott Nicole Brown , VanSickle Tamitha , Friesen Robert H.
Published: December 2004

Background:  Sedation of children is administered by nonanaesthesiologists in a variety of locations within our children's hospital. The purpose of this study was to assess the depth of sedation administered to children in four locations using the Bispectral Index (BIS) and the University of Michigan Sedation Scale (UMSS).

Methods:  Eighty‐six children under the age of 12 years undergoing procedures with conscious or deep sedation were enrolled. The study included patients undergoing cardiac catheterization, computerized tomography imaging, gastrointestinal endoscopy, and dental procedures. Sedation for each procedure was based on departmental protocols and preferences; the study did not dictate choice or dose of drugs. An independent observer applied the UMSS sedation scale at 10 min intervals for 1 h. The observer and the personnel administering sedation were blinded to the BIS score, which was recorded continuously.

Results:  The goal of either conscious or deep sedation was attained in 53% (BIS) and 72% (UMSS) of patients. Depth consistent with general anaesthesia was observed in 35% (BIS) and 0% (UMSS), and an awake state was observed in 12% (BIS) and 28% (UMSS). About 8% of patients experienced desaturation and airway events associated with deeper levels of sedation.

Conclusions:  Our data demonstrate wide variations in depth of sedation attained in the hospital. The goal of either conscious or deep sedation was not achieved in a significant number of children. This is a therapeutic failure that requires reassessment of sedation protocols and investigation of new approaches.
Child related background factors affecting compliance with induction of anaesthesia
Authors: Proczkowska‐Björklund Marie , Svedin Carl Göran
Published: December 2004

Background:  Factors such as age, sex, behaviour problems, fears, earlier traumatic hospital events and reactions to vaccination were assessed together with behaviour observed before premedication in order to evaluate their importance in predicting response to the anaesthetic process. The anaesthetic process was divided into four endpoints; compliance when given premedication, sedation, compliance during needle insertion or when an anaesthetic mask was put in place and behaviour when put to sleep.

Methods:  A total of 102 children who were undergoing day‐stay surgery and overnight stay surgery were video‐filmed during premedication and anaesthetic induction. Before premedication the children and parents answered questionnaires about behaviour [Preschool Behaviour Check List (PBCL)] and fears [Fears Survey Schedule for Children‐Revised (FSSC‐R)]. The films were analysed to assess behaviour before and after premedication and during induction of anaesthesia. A semistructured interview was conducted with the parents during the time the children were asleep.

Results:  There was a significantly higher odds ratio for noncompliant behaviour during premedication if the child placed itself in the parent's lap or near the parent or had previously experienced traumatic hospital events. The odds ratio for not being sedated by premedication was higher if compliance was low when premedication was given or the child had experienced a traumatic hospital event in the past. A high odds ratio for noncompliant behaviour during venous access or placement of an anaesthetic mask was seen if the child was not sedated or the child had had a negative reaction when vaccinated. The odds ratio for falling asleep in an anxious or upset state was higher if the child had shown noncompliant behaviour during premedication, had not been sedated or had shown noncompliant behaviour during venous access or facemask placement.

Conclusions:  The overall most important factor that predicts noncompliant behaviour and a distressed state in the child during the anaesthetic process was the experience of earlier traumatic hospital events including negative reaction to vaccination. All elements of the process are important in determining what will happen and all steps will influence how the child reacts when put to sleep.
Perioperative hypertension due to undiagnosed aortic coarctation: are current standards of care adequate?
Authors: Rose Michael , Murrell David
Published: December 2004

A 12‐year‐old male presented for a superficial parotidectomy for chronic parotitis. The patient had an unremarkable past medical history and was admitted on the day of surgery for his procedure without further anaesthetic or surgical review. During the patient's intraoperative course, higher than expected blood pressures were noted and treated with clonidine. After further high blood pressure readings in the postoperative care unit, close surveillance of blood pressures for the following 24 h was arranged. The hypertension was ongoing, and further examination and investigation confirmed the diagnosis of coarctation of the aorta. We examine the possible reasons for failure to diagnose this patient's hypertension preoperatively and suggest that there is a need for greater surveillance of blood pressures in the paediatric population presenting for surgery. A discussion of the significance of hypertension in paediatrics and recommendations for minimum standards of care to address shortcomings in the diagnosis and treatment of paediatric hypertension are proposed.