| 1. |
- Andréll, Paulin, 1978, et al.
(författare)
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White matter disease in magnetic resonance imaging predicts cerebral complications after coronary artery bypass grafting
- 2005
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Ingår i: The Annals of thoracic surgery. - 1552-6259. ; 79:1
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The aim of the present study was to assess neurologic and neuropsychologic complications in 104 patients randomized to coronary artery bypass grafting or spinal cord stimulation. An additional objective of the study was to assess whether preoperative white matter disease might predict cerebral complications, as previous studies have shown that there is a relationship between white matter disease and neuropsychologic decline after coronary artery bypass grafting. METHODS: The patients were subjected to neurologic examination before and six months after intervention. The patients underwent a cerebral magnetic resonance imaging before intervention and the presence of white matter disease was related to development of cerebral complications. RESULTS: More patients in the bypass group than in the spinal cord stimulation group developed focal cerebral ischemia (p < 0.05) and astheno-emotional disorder (p < 0.001). More patients with white matter disease undergoing bypass were affected by focal cerebral ischemia (p < 0.01) and astheno-emotional disorder (p < 0.001) after the intervention compared to patients with white matter disease undergoing spinal cord stimulation. In patients with no white matter disease there were no differences between the bypass group and spinal cord stimulation group with regard to cerebral complications. CONCLUSIONS: Patients undergoing bypass had more neurologic and neuropsychologic complications than patients undergoing spinal cord stimulation. Furthermore, patients with white matter disease were affected by cerebral complications in a higher extent after bypass than after spinal cord stimulation. Thus, preoperative assessment of white matter disease before undergoing coronary artery bypass grafting might predict the patient's risk of developing cerebral injury.
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| 2. |
- Carlson, Tobias, 1976, et al.
(författare)
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Interference of transcutaneous electrical nerve stimulation with permanent ventricular stimulation: a new clinical problem?
- 2009
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Ingår i: Europace. - 1532-2092. ; 11:3, s. 364-9
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Tidskriftsartikel (refereegranskat)abstract
- AIMS: To assess the compatibility of thoracic TENS and permanent PM treatment and to identify any signs of interference of TENS with the PM function. METHODS AND RESULTS: Twenty-seven patients treated with PM were tested. Transcutaneous electric nerve stimulation electrodes were placed above each mamilla, and the stimulation intensity was increased to the maximum level tolerated for 30 s or until electrocardiogram revealed signs of interference. Transcutaneous electric nerve stimulation of 2 and 80 Hz was tested with the PM ventricular sensing level set to the clinically chosen level as well as to maximal sensitivity. Interference was detected in 22 of 27 patients (81%). Low-frequency (2 Hz) stimulation was more associated with PM interference (52% at normal vs. 81% at maximal ventricular sensitivity) than high-frequency (80 Hz) stimulation (33% at normal vs. 63% at maximal ventricular sensitivity); although the differences were not statistically significant. CONCLUSION: Transcutaneous electric nerve stimulation frequently induces inhibition of the PM function already at the clinically set ventricular sensitivity. Therefore, individual testing is warranted before TENS treatment is considered in patients with a PM. A test protocol for TENS and PM interaction is proposed.
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| 3. |
- Ekre, Olof, 1965
(författare)
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Severe angina pectoris and spinal cord stimulation. Long-term effects and safety aspects
- 2003
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Refractory angina pectoris has been defined as coronary artery disease and severe angina, where standard pharmacological and invasive treatment possibilities are exhausted. The epidemiology of this condition is virtually unknown.During the last few decades, additional treatment options have evolved for this condition. Spinal cord stimulation (SCS) has been used since more than 15 years as additional symptom-relieving treatment for patients with severe angina pectoris. SCS has anti-ischemic effects and is safe and effective in clinical use. The extent of refractory angina pectoris among patients that had undergone coronary angiography was assessed in a defined geographic area, and the patients were characterised in terms of concurrent diseases, treatment, functional class, quality of life and the reasons for being considered inappropriate for revascularisation. Within two years, 100 patients were included. The mean age was 73 years, 26% were female and 59% of the patients had previously been subjected to revascularisation. In conclusion, there was a considerable number of patients with refractory angina, whose quality of life and functional status were severely impaired. However, rather few of these patients had congestive heart failure, renal dysfunction or pulmonary disease. The main reasons for rejection for revascularisation were unsuitable coronary anatomy and extracardiac diseases.The patients in the ESBY study (a randomised comparison of SCS and coronary artery bypass grafting (CABG) in 104 patients with severe angina and increased surgical risk) were followed up concerning long-term mortality, quality of life and cost-effectiveness. SCS as well as CABG turned out to offer these patients long-lasting improvement in quality of life, and the mortality was comparable with similar patient groups in other studies, and there were no differences between the two treatment groups. The health care costs were lower in the SCS group. Furtermore, there were no serious complications related to the SCS treatment. Eighteen patients with cardiac pacemaker as well as spinal cord stimulator were assessed concerning the safety of the combined treatment. A test procedure was performed and the patients were followed-up using a questionnaire. There was no interference between the two devices in any of the patients. A testing protocol for individual testing is proposed in the paper.The angina symptom changes were assessed in 32 patients with temporary cessation in long-term SCS treatment. There was a marked increase in symptoms during withheld treatment, which was promptly relieved after restitution of the SCS treatment.Conclusion Refractory angina was confirmed to be a considerable problem, where the average patient was younger and in a better general somatic condition than expected. Spinal cord stimulation, which is one of the treatment options for these patients, turned out to be safe (in terms of mortality, absence of serious complications and compatibility with cardiac pacemakers) and effective (in terms of symptom relief, quality of life and cost-effectiveness) during long-term treatment.
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| 4. |
- Odenstedt, Jacob, 1968, et al.
(författare)
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Spinal cord stimulation effects on myocardial ischemia, infarct size, ventricular arrhythmia, and noninvasive electrophysiology in a porcine ischemia-reperfusion model.
- 2011
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Ingår i: Heart Rhythm. - : Elsevier BV. - 1556-3871 .- 1547-5271. ; Jan:18
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Susceptibility to ventricular arrhythmias and sudden cardiac death can be reduced by modulation of autonomic tone. Spinal cord stimulation (SCS) presumably affects autonomic tone and reduces myocardial ischemia. OBJECTIVE: The purpose of this study was to investigate whether SCS could reduce myocardial ischemia, infarct size, and ventricular arrhythmias as well as repolarization alterations in a porcine ischemia-reperfusion model. METHODS: Anesthetized common Landrace pigs were randomized to SCS (n = 10) or sham treatment (n = 10) before, during, and after 45 minutes of coronary occlusion. Area at risk, infarct size, and spontaneous ventricular arrhythmias were analyzed. Continuous three-dimensional vectorcardiograms was recorded and analyzed with respect to ECG intervals, ST-segment, and T-vector and T-vector-loop morphology. RESULTS: SCS was associated with significantly (P <.04) fewer episodes of nonsustained ventricular tachycardia (NSVT) and sustained ventricular tachycardia (SVT), particularly during mid-left anterior descending artery (LAD) occlusion (SCS vs non-SCS; NSVT, mid- and proximal LAD: 0 vs 22 and 45 vs 72; SVT, mid- and proximal LAD: 3 vs 15 and 5 vs 5). No difference in ventricular fibrillation episodes was observed. The SCS group had significantly less ST elevation (P <.03) but similar area at risk, infarct size, and ratio of infarct size/area at risk. Ischemia induced increases of T(amplitude) and T(area) suggesting increased repolarization gradients, which were significantly reduced by SCS (P <.01 for both). CONCLUSION: SCS appears to have an antiarrhythmic effect on spontaneous NSVT and SVT during ischemia-reperfusion in association with a reduction of repolarization alterations. Vectorcardiography signs of myocardial ischemia were reduced by SCS, but this intervention was not accompanied by any effect on infarct size.
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