Zeitschrift für Kardiologie
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Randomized Controlled Trial Multicenter Study Clinical Trial
[Is ICD-programming for double intraoperative defibrillation threshold energy safe and effective during long-time follow-up? Results of a prospective randomized multicenter study (Low-Energy Endotak Trial--LEET)].
The aim of this prospective and randomized study was to evaluate the safety and efficacy of a reduced shock strength in transvenous implantable defibrillator therapy. So far clinical data concerning the safety margin of the shock energy in ICD therapy do not exist. The shock energy tested during long-term follow-up in this study was twice the intraoperatively measured defibrillation threshold (DFT). ⋯ At a mean follow-up of two years there was no significant difference between the two groups concerning the incidence of sudden cardiac death (2.4% in the study group vs. 3.8% in the control group). In conclusion programming the first shock with the ICD lead system used in this study at 2x DFT+ is as efficient as a shock energy of 34 J in order to terminate induced and spontaneous episodes of VT/VF. Thus, the safety of ICD-therapy is not impaired when programming the shock energy at the 2x DFT+ value.
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Randomized Controlled Trial Comparative Study Clinical Trial
[Differential therapy of cardiogenic shock with dopamine/milrinone in comparison with dopamine/dobutamine].
In cardiogenic shock, combined pharmacotherapy with dopamine/dobutamine was being used as a standard regimen and was compared to dopamine/milrinone in this study. In a total of 20 patients with persistent hemodynamic depression despite mechanical ventilation plus dopamine (10-12 micrograms/kg/min) and nitroglycerin (33 micrograms/min) infusions additional therapy with dobutamine (maximal dose: 9 micrograms/kg/min; n = 10) or milrinone (0.5 microgram/kg/min; n = 10) was started. Dobutamine induced an increase of cardiac index (2.0 +/- 0.1 to 2.9 +/- 0.21/min/m2; p < 0.01; mean +/- SEM) and heart rate (96 +/- 6 to 117 +/- 5 min-1; p < 0.05) while mean arterial pressure (75 +/- 2 to 71 +/- 4 mm Hg) and pulmonary capillary wedge pressure (21 +/- 2 to 19 +/- 2 mm Hg) hardly changed. ⋯ The rate-pressure product declined (11033 +/- 711 to 10555 +/- 929 mm Hg/min). In comparison, dopamine/milrinone appeared to be advantageous in terms of pre- and afterload reduction and myocardial oxygen demand. However, the concomitant decline in arterial pressure might impair end-organ perfusion.
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Randomized Controlled Trial Comparative Study Clinical Trial
[Nocturnal oxygen administration and cardiac arrhythmias during Cheyne-Stokes respiration in patients with heart failure].
Cheyne-Stokes respiration (CSR) is common during sleep in patients with severe congestive heart failure. It is not clear, if there is a relation between CSR and arrhythmias. Therefore in this study the impact of the nocturnal CSR on ventricular arrhythmias and the heart rate, as well as the influence of nasal nocturnal oxygen on CSR and sleep was studied. ⋯ Due to the high day-today variability these differences were not significant, but the decrease of average nocturnal heart rate with oxygen was (71 +/- 14 vs 68 +/- 14/min; p < 0.05). In conclusion, nocturnal oxygen causes a reduction of CSR, an improvement of sleep and a decrease of arousals. A significant reduction of arrhythmias by nocturnal oxygen could not be proved.
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Randomized Controlled Trial Comparative Study Clinical Trial
[The use of digitalis glycosides in atrial fibrillation].
The role of cardiac glycosides for conversion of atrial fibrillation to simus rhythm is controversially discussed. In a prospective study, 45 patients with paroxysmal atrial fibrillation were randomly assigned to one of three treatment groups (of 15 patients each). ⋯ The use of digoxin remains a mainstay of treatment for rate control in atrial fibrillation. To convert atrial fibrillation to sinus rhythm, however, the addition of a type I or III antiarrhythmic agent is necessary.
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Randomized Controlled Trial Clinical Trial
[Modification of thrombocyte function in diagnostic and therapeutic interventions in cardiology].
In patients with coronary heart disease platelet activity may be pathologically increased. Administration of platelet inhibitor drugs is an established treatment principle. The interactions between platelet activation, platelet inhibitor drugs like acetylsalicylic acid (ASA) or molsidomine and the endogenous fibrinolysis were studied in three trials. ⋯ Following successful coronary angioplasty 393 patients were randomized to receive either molsidomine (2 x 8 mg/d) or ASA (1 x 500 mg/d) plus nifedipine (3 x 20 mg/d). Coronary angiography performed after the 6 month treatment period revealed a restenosis rate of 29% in the molsidomine group and of 33% in patients treated with ASA + nifedipine. This difference was not statistically significant.