Rapid Ventricular Pacing for Flow Arrest During Cerebrovascular Surgery: Revival of an Old Concept

2011 ◽  
Vol 70 (suppl_2) ◽  
pp. ons270-ons275 ◽  
Author(s):  
Vera Saldien ◽  
Tomas Menovsky ◽  
Margo Rommens ◽  
Gregory Van der Steen ◽  
Katrin Van Loock ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Normal Sinus Rhythm ◽  
Interventional Cardiology ◽  
Ventricular Pacing ◽  
Normal Sinus ◽  
Arterial Blood ◽  
Rapid Ventricular Pacing ◽  
Cerebrovascular Surgery ◽  
Intraoperative Rupture ◽  
Produce Flow

ABSTRACT BACKGROUND: Intraoperative rupture of a cerebral aneurysm can be a devastating event that increases operative morbidity and mortality. Rapid ventricular pacing (RVP) is a technique used in interventional cardiology to obtain flow arrest for short periods of time. OBJECTIVE: To present our experience using RVP for flow arrest during cerebrovascular surgery. METHODS: We used RVP to produce flow arrest for periods of 40 seconds in 12 patients who underwent craniotomy for a cerebrovascular disorder (11 aneurysms and 1 arteriovenous malformation). RESULTS: During RVP, there was an immediate and significant reduction of blood pressure in each patient. The maximum degree of hypotension was obtained 3.2 ± 0.7 seconds (mean ± SD) after the start of RVP. When RVP was terminated, normal sinus rhythm returned instantaneously, along with recovery of indexes of hemodynamic function. Subjectively, the decrease in blood pressures facilitated dissection, and during clipping, the aneurysm sac felt softer and was easier to manipulate. No complications related to RVP occurred. CONCLUSION: Rapid ventricular pacing during cerebrovascular surgery is an effective method for lowering the arterial blood pressure in a controlled and directly reversible manner. Advances in cardiology now make RVP a promising and safe technique that can facilitate complex cerebrovascular surgery.

Effect of short-term rapid ventricular pacing followed by pacing interruption on arterial blood pressure in healthy pigs and pigs with tachycardiomyopathy

2014 ◽  
Vol 17 (1) ◽  
pp. 85-91
Author(s):  
P. Skrzypczak ◽  
D. Zyśko ◽  
U. Pasławska ◽  
A. Noszczyk-Nowak ◽  
A. Janiszewski ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Ventricular Tachycardia ◽  
Diastolic Blood Pressure ◽  
General Anaesthesia ◽  
Control Group ◽  
Ventricular Pacing ◽  
Short Term ◽  
Arterial Blood ◽  
Rapid Ventricular Pacing ◽  
Baseline Conditions

Abstract Ventricular tachycardia may lead to haemodynamic deterioration and, in the case of long term persistence, is associated with the development of tachycardiomyopathy. The effect of ventricular tachycardia on haemodynamics in individuals with tachycardiomyopathy, but being in sinus rhythm has not been studied. Rapid ventricular pacing is a model of ventricular tachycardia. The aim of this study was to determine the effect of rapid ventricular pacing on blood pressure in healthy animals and those with tachycardiomyopathy. A total of 66 animals were studied: 32 in the control group and 34 in the study group. The results of two groups of examinations were compared: the first performed in healthy animals (133 examinations) and the second performed in animals paced for at least one month (77 examinations). Blood pressure measurements were taken during chronic pacing - 20 min after onset of general anaesthesia, in baseline conditions (20 min after pacing cessation or 20 min after onset of general anaesthesia in healthy animals) and immediately after short-term rapid pacing. In baseline conditions significantly higher systolic and diastolic blood pressure was found in healthy animals than in those with tachycardiomyopathy. During an event of rapid ventricular pacing, a significant decrease in systolic and diastolic blood pressure was found in both groups of animals. In the group of chronically paced animals the blood pressure was lower just after restarting ventricular pacing than during chronic pacing. Cardiovascular adaptation to ventricular tachycardia develops with the length of its duration. Relapse of ventricular tachycardia leads to a blood pressure decrease more pronounced than during chronic ventricular pacing

scholarly journals Efficacy of Adenosine versus Verapamil for Management of Supraventricular Tachycardia Post- Coronary Artery Bypass Grafting: A Randomized Trial

2021 ◽  
Author(s):  
Hoda Shokri ◽  
Ihab Ali
Keyword(s):  
Blood Pressure ◽  
Adverse Events ◽  
Sinus Rhythm ◽  
Supraventricular Tachycardia ◽  
Normal Sinus Rhythm ◽  
Artery Bypass ◽  
Study Groups ◽  
Normal Sinus ◽  
Arterial Blood ◽  
Significant Difference

Abstract Background The aim is to compare the use of adenosine and verapamil for management of postoperative supraventricular tachycardia in terms of time of conversion of SVT to normal sinus rhythm, success rate, hospital stay length and adverse eventsMethods Patients (54–65 years old) received adenosine or verapamil groups. In the adenosine group, patients received IV adenosine 6 mg bolus then wait 2 minutes, if it failed another 12 mg IV of adenosine was administered. In the verapamil group, patients received IV verapamil 5mg bolus slowly over 2 minutes followed by a second IV bolus of 10 mg, 30 minutes after the initial dose in persistent supraventricular tachycardia (SVT). If SVT persisted, the patient was shifted to adenosine. Results Patients were followed up regarding the efficacy of drug, blood pressure, mean time of conversion of SVT (time elapsed from effective dose of the study drug till conversion of SVT to sinus rhythm) and incidence of adverse events were recorded. The efficacy of adenosine was significantly higher than verapamil (P <0.001). The time of conversion of SVT to sinus rhythm was significantly shorter in adenosine group compared with verapamil group (P < 0.001). The incidence of hypotension was comparable between the study groups. The mean arterial blood pressure and the incidence of complications were comparable.Conclusions Intravenous administration of adenosine effectively treat SVT in terms of higher efficacy and shorter time of conversion of SVT to normal sinus rhythm compared with verapamil without any significant difference regarding the incidence of side effects between the study groups.Trial registrationThis study was approved by Medical ethics committee of Ain Shams University approval number FMASU R 62/ 2019). and the protocol was prospectively registered at ClinicalTrials.gov : NCT 04203368 on December 16, 2019.

Characterization of baroreflex impairment in conscious dogs with pacing-induced heart failure

1993 ◽  
Vol 265 (5) ◽  
pp. R1132-R1140 ◽  
Author(s):  
N. B. Olivier ◽  
R. B. Stephenson
Keyword(s):  
Heart Failure ◽  
Blood Pressure ◽  
Heart Rate ◽  
Cardiac Output ◽  
Peripheral Resistance ◽  
Open Loop ◽  
Ventricular Pacing ◽  
Baroreflex Control ◽  
Rapid Ventricular Pacing ◽  
Reflex Control

Open-loop baroreflex responses were evaluated in eight conscious dogs before and during congestive heart failure to determine the effects of failure on baroreflex control of blood pressure, heart rate, cardiac output, and total peripheral resistance. Heart failure was induced by rapid ventricular pacing. Baroreflex function was determined by calculation of the range and gain of the open-loop stimulus-response relationships for the effect of carotid sinus pressure on blood pressure, heart rate, cardiac output, and total peripheral resistance. The range and gain of blood pressure responses were substantially reduced as early as 3 days after induction of heart failure (161 +/- 6 to 99 +/- 8 mmHg and -2.7 +/- 0.3 to -1.5 +/- 0.1, respectively) and remained depressed for the 21 days of heart failure. This depression in baroreflex control of blood pressure was associated with similar depressions in reflex range and gain for heart rate (125 +/- 9 to 78 +/- 11 beats/min and -2.05 +/- 0.2 to -1.16 +/- 0.2 beats/min, respectively) and cardiac output (1.74 +/- 0.2 to 0.46 +/- 0.2 l/min and -0.81 +/- 0.02 to -0.027 +/- 0.008 l/min, respectively). The group-averaged range and gain for reflex control of vascular resistance were not altered by heart failure. In three dogs, discontinuation of rapid ventricular pacing led to resolution of heart failure within 7 days and partial restoration of the range and gain of reflex control of blood pressure. We conclude that heart failure reversibly depresses baroreflex control of blood pressure principally through a concurrent reduction in reflex control of cardiac output, whereas reflex control of vascular resistance is not consistently affected.

scholarly journals Syncope Caused by Huge Hiatal Hernia

2011 ◽  
Vol 2011 ◽  
pp. 1-2 ◽  
Author(s):  
Gabriel Vanerio
Keyword(s):  
Blood Pressure ◽  
Hiatal Hernia ◽  
Normal Sinus Rhythm ◽  
White Female ◽  
Loss Of Consciousness ◽  
X Ray ◽  
Normal Sinus ◽  
Carbonated Soft Drinks ◽  
Chest X Ray ◽  
Careful History

A 84-year-old white female had a brief loss of consciousness while playing bridge. A few minutes before the episode she had eaten pizza and significant amount of carbonated soft drinks. After recovery, her friends noticed that she was alert, but pale and sweating. Upon arrival at the emergency room, sitting blood pressure was 160/60 mmHg with a normal sinus rhythm. A chest X-Ray was performed, which was essential to make the diagnosis. The X-Ray showed a large retrocardiac opacity with air and liquid level compatible with a giant hiatus hernia. After a copious snack the hiatal hernia compressed the left atrium, decreasing the left cardiac output, elucidating the mechanism of the syncopal episode. In patients presenting with swallow syncope (particularly after a copious meal, validating the importance of a careful history), a chest X-Ray should be always be performed.

scholarly journals Transvenous embolization of thalamic arteriovenous malformation under transient cardiac standstill

2019 ◽  
Vol 46 (Suppl_1) ◽  
pp. V10
Author(s):  
Leonardo Rangel-Castilla ◽  
Hussain Shallwani ◽  
Adnan H. Siddiqui
Keyword(s):  
Magnetic Resonance Imaging ◽  
Arteriovenous Malformation ◽  
Transarterial Embolization ◽  
Endovascular Embolization ◽  
Transvenous Embolization ◽  
Ventricular Pacing ◽  
Resonance Imaging ◽  
Rapid Ventricular Pacing ◽  
One Year ◽  
Cerebrovascular Surgery

Transvenous embolization (TE) has been increasingly applied for arteriovenous malformation (AVM) treatment. Transient cardiac standstill (TCS) has been described in cerebrovascular surgery but is uncommon for endovascular embolization. The authors present a patient with a ruptured thalamic AVM in whom both techniques were applied simultaneously. Surgery was considered, but the patient refused. Transarterial embolization was performed with an incomplete result. The deep-seated draining vein provided sole access to the AVM. A microcatheter was advanced into the draining vein. Under TCS, achieved with rapid ventricular pacing, complete AVM embolization was obtained. One-year magnetic resonance imaging and cerebral angiography demonstrated no residual AVM.The video can be found here: https://youtu.be/CAzb9md_xBU.

Rapid Ventricular Pacing to Lower Blood Pressure During Endograft Deployment in the Thoracic Aorta

2006 ◽  
Vol 81 (5) ◽  
pp. e21-e23 ◽  
Author(s):  
Suwatchai Pornratanarangsi ◽  
Mark W.I. Webster ◽  
Peter Alison ◽  
Parma Nand
Keyword(s):  
Blood Pressure ◽  
Thoracic Aorta ◽  
Ventricular Pacing ◽  
Lower Blood Pressure ◽  
Lower Blood ◽  
Rapid Ventricular Pacing

scholarly journals Comparison of two oscillometric blood pressure monitors in subjects with atrial fibrillation

2010 ◽  
Vol 33 (1) ◽  
pp. 54 ◽  
Author(s):  
Tyler S Lamb ◽  
Amar Thakrar ◽  
Mahua Ghosh ◽  
Merne P Wilson ◽  
Thomas W Wilson
Keyword(s):  
Atrial Fibrillation ◽  
Blood Pressure ◽  
Health Care ◽  
Heart Rate ◽  
Health Care Professionals ◽  
Gold Standard ◽  
Normal Sinus Rhythm ◽  
Normal Sinus ◽  
Therapeutic Decisions ◽  
Blood Pressure Monitors

Objective: To compare blood pressure readings obtained with two commonly used oscillometric monitors: Omron HEM 711 AC (OM) and Welch-Allyn 52000 series NIBP/oximeter (WA) with mercury sphygmomanometers (Merc) in subjects with atrial fibrillation. Methods: We recruited 51 hemodynamically stable subjects with atrial fibrillation. Fifty four subjects in normal sinus rhythm served as controls. Supine blood pressure readings in each arm were recorded simultaneously using one monitor and Merc. The second monitor then replaced the first and readings were repeated. Merc was then switched to the opposite arm, and both monitors retested. Apical heart rates were ascertained with a stethoscope. We used the averaged, same arm Merc readings as “gold standard”. Results: Automated blood pressure readings were obtained in all control subjects and in all but three of those with atrial fibrillation. Both monitors, and operators, noted a difference between apical and radial/brachial pulse rates: apical-recorded: Merc 6.1±15.0; OM 5.5±13.7; WA 10.0±21.2 beats per minute. Both monitors were accurate in controls: over 90% of readings were within 10 mmHg of averaged Merc, and both achieved European Hypertension Society standards. In subjects with atrial fibrillation, about one quarter of all oscillometric readings differed from Merc by more than 10 mmHg. Both falsely high and falsely low readings occurred, some up to 30 mmHg. There was no relation between accuracy and heart rate. Conclusions: Single blood pressure readings, taken with oscillometric monitors in subjects with atrial fibrillation differ, often markedly, from those taken manually. Health care professionals should record multiple readings manually, using validated instruments when making therapeutic decisions.

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