bluuebunny/crossref_metadata_2025_split huggingface dataset:
Chronic Augmentation of the Parasympathetic Tone to the Atrioventricular Node: A Nonthoracotomy Neurostimulation Technique for Ventricular Rate Control During Atrial Fibrillation
Authors: MISCHKE KARL , ZARSE MARKUS , SCHMID MICHAEL , GEMEIN CHRISTOPHER , HATAM NIMA , SPILLNER JAN , DOHMEN GUIDO , RANA OBAIDA , SAYGILI EROL , KNACKSTEDT CHRISTIAN , WEIS JOACHIM , PAUZA DAINIUS , BIANCHI STEFANO , SCHAUERTE PATRICK 
Published: October 2009

Long‐Term Cardiac Neurostimulation.

Introduction:
The right inferior ganglionated plexus (RIGP) selectively innervates the atrioventricular node. Temporary electrical stimulation of this plexus reduces the ventricular rate during atrial fibrillation (AF). We sought to assess the feasibility of chronic parasympathetic stimulation for ventricular rate control during AF with a nonthoracotomy intracardiac neurostimulation approach.
Methods and Results:
In 9 mongrel dogs, the small endocardial area inside the right atrium, which overlies the RIGP, was identified by 20 Hz stimulation over a guiding catheter with integrated electrodes. Once identified, an active‐fixation lead was implanted. The lead was connected to a subcutaneous neurostimulator. An additional dual‐chamber pacemaker was implanted for AF induction by rapid atrial pacing and ventricular rate monitoring. Continuous neurostimulation was delivered for 1–2 years to decrease the ventricular rate during AF to a range of 100–140 bpm. Implantation of a neurostimulation lead was achieved within 37 ± 12 min. The latency of the negative dromotropic response after on/offset or modulation of neurostimulation was <1 s. Continuous neurostimulation was effective and well tolerated during a 1–2 year follow‐up with a stimulation voltage <5 V. The neurostimulation effect displayed a chronaxie‐rheobase behavior (chronaxie time of 0.07 ± 0.02 ms for a 50% decrease of the ventricular rate during AF).
Conclusion:
Chronic parasympathetic stimulation can be achieved via a cardiac neurostimulator. The approach is safe, effective, and well tolerated in the long term. The atrioventricular nodal selectivity and the opportunity to adjust the negative dromotropic effect within seconds may represent an advantage over pharmacological rate control. (J Cardiovasc Electrophysiol, Vol. 21, pp. 193‐199, February 2010)
Electrocardiographic Findings, Device Therapies, and Comorbidities in Octogenarian Implantable Defibrillator Recipients
Authors: DANIELS JAMES D. , SAUNDERS JUSTIN , PARVATHANENI SUNTHOSH , BYRD AMANDA , JOGLAR JOSE A. , OBEL OWEN 
Published: October 2009

Implantable Defibrillators in Octogenarians.
Background: The use of implantable cardioverter‐defibrillators (ICDs) in octogenarians is poorly defined. Objective: To assess baseline electrocardiographic (ECG) findings, arrhythmia episodes, and development of severe nonarrhythmic illness or death in patients aged ≥80 years at ICD implantation, and to compare them with younger patients. Methods: Medical records and device interrogations for 199 patients ≥70 years old who underwent ICD implantation were reviewed. Patients were divided into 3 groups based on age at the time of implant: age 70–74 (group 1; 88 patients), age 75–79 (group 2; 67 patients), and age ≥80 (group 3; 44 patients). Results: ECGs: Octogenarians were more likely to have sinus bradycardia (SB) (P = 0.047) and left bundle branch block (LBBB) (P = 0.043) compared to younger patients. There was no difference among groups in the proportion of patients with atrial fibrillation or any degree of AV block. Therapies: There was no difference between age groups in any therapy (P = 0.78), appropriate therapy (P = 0.54), or inappropriate therapy (P = 0.21) per patient‐year. There was no difference between groups in time‐to‐first therapy of any type (P = 0.71). Nonarrhythmic death/morbidity: There was no difference between groups in time to death or serious illness. Conclusion: Our study is the first to evaluate in detail the therapies received by octogenarians after ICD placement. The higher incidence of SB and LBBB might influence the number of pacing sites in octogenarian patients. Very elderly patients have similar rates of arrhythmic episodes and development of severe comorbidities as septuagenarians, and they should not be denied ICD implantation based solely on age. (J Cardiovasc Electrophysiol, Vol. 21, pp. 236–241, March 2010)
Characteristics of Complex Fractionated Electrograms in Nonpulmonary Vein Ectopy Initiating Atrial Fibrillation/Atrial Tachycardia
Authors: LO LI‐WEI , LIN YENN‐JIANG , TSAO HSUAN‐MING , CHANG SHIH‐LIN , HU YU‐FENG , TSAI WEN‐CHIN , TUAN DA‐CHUN , CHANG CHIEN‐JUNG , LEE PI‐CHANG , TAI CHING‐TAI , TANG WEI‐HUA , SUENARI KAZUYOSHI , HUANG SHIH‐YU , HIGA SATOSHI , CHEN SHIH‐ANN 
Published: October 2009

Background:
Nonpulmonary vein (PV) ectopy initiating atrial fibrillation (AF)/atrial tachycardia (AT) is not uncommon in patients with AF. The relationship of complex fractionated atrial electrograms (CFAEs) and non‐PV ectopy initiating AF/AT has not been assessed. We aimed to characterize the CFAEs in the non‐PV ectopy initiating AF/AT.
Methods:
Twenty‐three patients (age 53 ± 11 y/o, 19 males) who underwent a stepwise AF ablation with coexisting PV and non‐PV ectopy initiating AF or AT were included. CFAE mapping was applied before and after the PV isolation in both atria by using a real‐time NavX electroanatomic mapping system. A CFAE was defined as a fractionation interval (FI) of less than 120 ms over 8‐second duration. A continuous CFAE (mostly, an FI < 50 ms) was defined as electrogram fractionation or repetitive rapid activity lasting for more than 8 seconds.
Results:
All patients (100%) with non‐PV ectopy initiating AF or AT demonstrated corresponding continuous CFAEs at the firing foci. There was no significant difference in the FI among the PV ostial or non‐PV atrial ectopy or other atrial CFAEs (54.1 ± 5.6, 58.3 ± 11.3, 52.8 ± 5.8 ms, P = 0.12). Ablation targeting those continuous CFAEs terminated the AF and AT and eliminated the non‐PV ectopy in all patients (100%). During a follow‐up of 7 months, 22% of the patients had an AF recurrence with PV reconnections. There was no recurrence of any ablated non‐PV ectopy during the follow‐up.
Conclusion:
The sites of the origin of the non‐PV ectopies were at the same location as those of the atrial continuous CFAEs. Those non‐PV foci were able to initiate and sustain AF/AT. By limited ablation targeting all atrial continuous CFAEs, the AF could be effectively eliminated.
The Impact of Catheter Ablation on the Dynamic Function of the Left Atrium in Patients with Atrial Fibrillation: Insights from Four‐Dimensional Computed Tomographic Images
Authors: TSAO HSUAN‐MING , HU WEI‐CHIH , WU MEI‐HAN , TAI CHING‐TAI , CHANG SHIH‐LIN , LIN YENN‐JIANG , LO LI‐WEI , HUANG CHIN‐CHOU , HU YU‐FENG , SHEU MING‐HUEI , CHANG CHENG‐YEN , CHEN SHIH‐ANN 
Published: October 2009

Functional Evaluation of the LA by Dynamic CT.
Introduction: Elucidating the functional properties and remodeling process of the entire left atrium (LA) is important not only for offering the mechanistic insight into atrial fibrillation (AF) but also for assessing the effectiveness of catheter ablation. Methods: We included 65 patients with paroxysmal AF and 29 controls. Baseline multidetector computed tomography (MDCT) was acquired in all subjects and a follow‐up MDCT was available in 48 patients after pulmonary vein and LA ablation. The 3‐dimensional images at atrial end‐diastole (ED) and end‐systole (ES) were analyzed. Results: The LA volume (ED: 61.11 ± 15.94 vs 54.12 ± 8.94 mL/m2, P = 0.03; ES: 45.29 ± 17.64 vs 33.38 ± 7.78 mL/m2, P < 0.001) was increased, and ejection fraction (EF) (26.93 ± 13.40 vs 38.09 ± 11.62%, P < 0.001) decreased in AF patients as compared to controls. After ablation, the ES LA volume (44.73 ± 14.93 vs 38.04 ± 11.51 mL/m2, P = 0.04) decreased and the LA EF (25.04 ± 13.13 vs 30.82 ± 7.85%, P = 0.03) increased in patients without any AF recurrence. The wall motion (WM) analysis of the 18 segments of LA revealed increased motional magnitudes of entire LA except for the anterior roof. In contrast, the volume, EF, and WM of LA remained similar in patients with recurrence. Conclusion: Dilated LA with global hypokinesia was noted in AF patients. Improved LA transport function was demonstrated in patients without any recurrence after ablation. However, the anatomic and functional reverse remodeling was not significant in patients with AF recurrence. (J Cardiovasc Electrophysiol, Vol. 21, pp. 270–277, March 2010)
Influence of Heavy Cigarette Smoking on Heart Rate Variability and Heart Rate Turbulence Parameters
Authors: Cagirci Goksel , Cay Serkan , Karakurt Ozlem , Eryasar Neslihan , Kaya Veli , Canga Aytun , Yesilay Asuman Bicer , Kilic Harun , Topaloglu Serkan , Aras Dursun , Demir Ahmet Duran , Akdemir Ramazan 
Published: October 2009

Background: Cigarette smoking increases the risk of cardiovascular events related with several mechanisms. The most suggested mechanism is increased activity of sympathetic nervous system. Heart rate variability (HRV) and heart rate turbulence (HRT) has been shown to be independent and powerful predictors of mortality in a specific group of cardiac patients. The goal of this study was to assess the effect of heavy cigarette smoking on cardiac autonomic function using HRV and HRT analyses. Methods: Heavy cigarette smoking was defined as more than 20 cigarettes smoked per day. Heavy cigarette smokers, 69 subjects and nonsmokers 74 subjects (control group) were enrolled in this study. HRV and HRT analyses [turbulence onset (TO) and turbulence slope (TS)] were assessed from 24‐hour Holter recordings. Results: The values of TO were significantly higher in heavy cigarette smokers than control group (−1.150 ± 4.007 vs −2.454 ± 2.796, P = 0.025, respectively), but values of TS were not statistically different between two groups (10.352 ± 7.670 vs 9.613 ± 7.245, P = 0.555, respectively). Also, the number of patients who had abnormal TO was significantly higher in heavy cigarette smokers than control group (23 vs 10, P = 0.006). TO was correlated with the number of cigarettes smoked per day (r = 0.235, P = 0.004). While LF and LF/HF ratio were significantly higher, standard deviation of all NN intervals (SDNN), standard deviation of the 5‐minute mean RR intervals (SDANN), root mean square of successive differences (RMSSD), and high‐frequency (HF) values were significantly lower in heavy smokers. While, there was significant correlation between TO and SDNN, SDANN, RMSSD, LF, and high frequency (HF), only HF was correlated with TS. Conclusion: Heavy cigarette smoking has negative effect on autonomic function. HRT is an appropriate noninvasive method to evaluate the effect of cigarette on autonomic function. Simultaneous abnormal HRT and HRV values may explain increased cardiovascular event risk in heavy cigarette smokers.
Assessment of Microvolt T‐Wave Alternans in High‐Risk Patients with the Congenital Long‐QT Syndrome
Authors: Schmitt Jörn , Baumann Stefan , Klingenheben Thomas , Richter Sergio , Duray Gabor , Hohnloser Stefan H. , Ehrlich Joachim R. 
Published: October 2009

Background: Microvolt T‐wave alternans (MTWA) has been used for arrhythmogenic risk stratification in cardiac disease conditions associated with increased risk of sudden cardiac death. Macroscopic T‐wave alternans has been observed in patients with congenital long‐QT syndrome (LQTS). The role of MTWA testing in patients with LQTS has not been established. Objective: To determine the diagnostic value of MTWA testing in high‐risk patients with LQTS. Methods and results: We assessed MTWA in 10 consecutive LQTS index patients who survived cardiac arrest or had documented torsade de pointes tachycardia and 6 first‐degree family members with congenital LQTS which had been genotyped in 13 of 16 subjects (7 index patients, 6 family members). No LQTS‐causing mutation was identified in 3 index patients with overt QT prolongation. MTWA was assessed during standardized bicycle exercise testing using the spectral method and yielded negative (n = 8) or indeterminate (n = 2) results in index patients, respectively. Similarly, all first‐degree family members tested MTWA negative except for one indeterminate result. Two genotype positive family members could not be tested (two children—4 and 9 years of age). Conclusion: In patients with congenital LQTS, free from structural heart disease and with a history of life‐threatening cardiac arrhythmias, assessment of MTWA does not yield diagnostic value. Hence, determination of MTWA in lower risk LQTS patients without spontaneous arrhythmic events is likely not to be useful for arrhythmia risk stratification.
Electrocardiographic Indices of Left Ventricular Hypertrophy and Repolarization Phase Share the Same Genetic Influences: A Twin Study
Authors: Mutikainen Sara , Ortega‐Alonso Alfredo , Alén Markku , Kaprio Jaakko , Karjalainen Jouko , Rantanen Taina , Kujala Urho M. 
Published: October 2009

Background: Both left ventricular hypertrophy (LVH) and repolarization phase (RP) are known to be attributable to genetic influences, but less is known whether they share same genetic influences. The aim of this study was to investigate to what extent individual differences in electrocardiographic (ECG) LVH and RP are explained by genetic and environmental influences and whether these influences are shared between these two traits. Methods: Resting ECG recordings were obtained from 186 monozygotic and 203 dizygotic female twin individuals, aged 63 to 76 years. Latent factors, called LVH and RP, were formed to condense the information obtained from LVH indices (Cornell voltage and Cornell product) and T‐wave amplitudes (leads V5 and II), respectively. Multivariate quantitative genetic modeling was used both to decompose the phenotypic variances into additive genetic, common environmental, and unique environmental influences, and for the calculation of genetic and environmental correlations between LVH and RP. Results: Additive genetic influences explained 16% of individual differences in LVH and 74% in RP. The remaining individual differences were explained by both common and unique environmental influences. The genetic correlation and unique environmental correlation between LVH and RP were −0.93 and −0.05, respectively. Conclusions: In older women without overt cardiac diseases, RP is under stronger genetic control than LVH. The majority of genetic influences are shared between LVH and RP whereas environmental influences are mainly specific to each.
Electrophysiologic Characteristics of Wide QRS Complexes during Pharmacologic Termination of Sustained Supraventricular Tachycardias with Verapamil and Adenosine: Observations from Electrophysiologic Study
Authors: Türkoğlu Cengizhan , Öztürk Muzaffer , Aliyev Farid , Firatli Inci , Incesoy Nilgün 
Published: October 2009

Background: In this study we evaluate wide QRS complexes observed during pharmacologic termination of supraventricular tachycardias. Methods: Patients with supraventricular tachycardia, undergoing electrophysiologic study were enrolled. 12 mg of adenosine or 10 mg of verapamil were administered during tachycardia, under continuous monitoring of intaracardiac and surface electrocardiograms. Electrocardiographic features of ventricular ectopy were noted. Results: Seventy‐four patients were enrolled. 48 patients were randomized to adenosine and 26 to verapamil. Five different appearance patterns of ventricular ectopy were observed during termination of tachycardias. All wide QRS complexes were of ventricular origin and all of them were observed during the termination of tachycardia. Adenosine more frequently resulted in appearance of ventricular beats (15.4% vs 41.7%, P = 0.003), and this was more frequently observed in patients with atrioventricular nodal reentrant tachycardia. Patients with ventricular beats were younger than those without, in both, verapamil (47.5 ± 15.6 vs 65.0 ± 8.8 years, P = 0.04) and adenosine (40.9 ± 13.8 vs 49.7 ± 16.8, P = 0.03) groups. Left bundle branch block (LBBB)/superior axis morphology was most frequent morphology in adenosine group (55%). Two of 4 patients in verapamil group displayed LBBB/inferior axis QRS morphology and another 2 patients displayed LBBB/superior axis morphology. Conclusions: Noncatheter induced, five different appearance patterns and four distinct morphologies of ventricular origin were observed. Most of them do not directly terminate tachycardia, but are associated with its termination and are not observed in ongoing tachycardia.
Correlation Relationship Assessment between Left Ventricular Hypertrophy Voltage Criteria and Body Mass Index in 41,806 Swiss Conscripts
Authors: Abächerli Roger , Zhou Lingchuan , Schmid Johann‐Jakob , Kobza Richard , Niggli Bernhard , Frey Franz , Erne Paul 
Published: October 2009

Introduction: Electrocardiographic criteria for left ventricular hypertrophy (LVH) have been limited by low sensitivity at acceptable levels of specificity. A number of studies have demonstrated that body mass index (BMI) is associated with decreased sensitivity of ECG LVH classification in hypertensive patients. The objective of this study is to investigate the correlation relationship between LVH voltage criteria and BMI in Swiss conscripts. Methods: A database of 41,806 young Swiss people, who underwent compulsory conscription for the Swiss Army, was compiled. Along with other medical data, an ECG was taken. Statistical analyses, such as linear regression and calculation of correlation coefficient, were carried out between LVH voltage criteria and BMI. Results: The mean age in the studied population was 19.2 ± 1.1 years with a median age of 19 years (range from 17 to 38 years). We found an overweight prevalence of 25.1%. The results showed that body habitus had significant association with Sokolow‐Lyon voltages. A mean decrease of 13%, 5%, 19%, 14%, and 12% for the five studied Sokolow‐Lyon indexes were found between normal range subjects (18.5 ≤ BMI < 25) and obese subjects (25≤ BMI). Conclusions: Our study confirms the hypothesis that people with higher BMI, a growing section of the population, have lower ECG amplitudes. Therefore, the Sokolow‐Lyon voltage criteria may underestimate the presence of LVH for subjects with higher BMI, which is not the case for the Cornell voltage. Our analysis suggests that computerized electrocardiography for the diagnosis of left ventricular hypertrophy based on Sokolow‐Lyon voltages should incorporate the BMI factor.
Progressive Cerebral Disease in Lymphomatoid Granulomatosis Causes Anterograde Amnesia and Neuropsychiatric Disorder
Authors: Carone Dominic A. , Benedict Ralph H. B. , Zivadinov Robert , Singh Baljinder , Ambrus Julian L. 
Published: October 2009

ABSTRACTThe authors report neuropsychological (NP) and serial quantitative magnetic resonance imaging (MRI) findings of a 29‐year‐old woman with lymphomatoid granulomatosis (LG). Disease course was characterized by acute psychosis, tremor, fever, seizures, and progressive cognitive impairment. At the time of symptom onset, brain MRI revealed mild lesion volume and normal parenchymal volume. This was followed by dramatic progression of brain lesions and atrophy over 2 years, at which point the patient expired. Atrophy was most prominent in the mesial temporal lobes. NP testing revealed marked amnesia and mild impairments in other cognitive domains. To our knowledge, this is the first recorded case of LG in which bilateral temporal lobe atrophy is evident and accompanied by anterograde amnesia. We speculate that temporal lobe atrophy was influenced by the established susceptibility of this region in various neurological diseases.
Lhermitte‐Duclos Disease: Case Report
Authors: Carlson Jeffrey J. , Milburn James M. , Barré Gregg M. 
Published: October 2009

ABSTRACTLhermitte‐Duclos disease is a rare disorder with an unknown pathogenesis. A single report of a pathological proven case of Lhermitte‐Duclos disease is presented with clinical, imaging, and histopathological findings. A brief review of the condition is provided with an emphasis on imaging description.
Unusual Case of 2 Renal Cell Carcinoma Metastases Ipsilateral to an Occluded Internal Carotid Artery
Authors: Erbay Sami H. , O'Callaghan Mark G. , Bhadelia Rafeeque A. , Polak Joseph F. 
Published: October 2009

ABSTRACTHemodynamic factors may play a role in the seeding and subsequent growth of cerebral metastasis. The authors present a case with 2 foci of cerebral metastasis in the same vascular territory ipsilateral to an occluded internal carotid artery. A 65‐year‐old man with chronic left frontal lobe infarct and left internal carotid artery occlusion was diagnosed with 2 large hemorrhagic metastases in the left middle cerebral artery territory. Diminished flow signals were seen in the trunk and branches of the left middle cerebral artery on magnetic resonance angiography. This case illustrates preferential seeding and growth of cerebral metastases in a region of the brain with diminished blood flow.
Comparison of Asymmetry in Cerebral Blood Flow Between Brain Hemispheres Using Digital Subtraction Angiography
Authors: Divani Afshin A. , Qureshi Adnan I. , Hoffman Kenneth R. , Suri M. Fareed K. , Kirmani Jawad F. 
Published: October 2009

ABSTRACT Background and Purpose. Recently, endovascular techniques have gained significant therapeutic potential for both treatment and prevention of stroke. Cerebral angiography, which is an essential component of these procedures, has been used to provide morphological information regarding condition of blood vessels. In this study, we propose to determine the possibility of acquiring information regarding cerebral blood flow (CBF) in addition to morphologic information from data routinely available during angiography. Methods. Digital subtraction angiography sequences were obtained for eight patients having occlusive disease in internal carotid artery (ICA) territories. Two regions‐of‐interest (ROIs) corresponding to the two brain hemispheres on AP view were delineated. For each image, the average pixel value within each ROI was calculated and used to generate time‐density curves. Indices obtained from each curve were compared with each other and with the results obtained from the single photon emission computed tomography (SPECT) studies performed a pre‐ or postangiography procedure. Results. Comparison between ICA stenosis and cerebral perfusion measurements revealed that cerebral perfusion deficit can be independent of arterial occlusive disease. The indices obtained from the time‐density curves exhibit a correlating trend with the results from SPECT studies. However, lack of sufficient sample data prevented any meaningful statistical analysis to be conducted. Conclusions. We have developed a technique for utilizing the angiographic data for the important task of routinely and easily measuring CBF. Availability of CBF measurements during cerebral angiography may favorably impact upon the appropriate use of endovascular procedures and potentially contribute to the reduction of morbidity and mortality associated with stroke.