scholarly journals Outcome of Resynchronization Therapy on Superficial and Endocardial Electrophysiological Findings

2018 ◽  
pp. S601-S610 ◽  
Author(s):  
O. KITTNAR ◽  
L. RIEDLBAUCHOVÁ ◽  
T. ADLA ◽  
V. SUCHÁNEK ◽  
J. TOMIS ◽  
...  
Keyword(s):  
Heart Failure ◽  
Sinus Rhythm ◽  
Body Surface ◽  
The Body ◽  
Control Group ◽  
Healthy Controls ◽  
Electroanatomical Mapping ◽  
Resynchronization Therapy ◽  
Activation Times ◽  
Spontaneous Rhythm

Cardiac resynchronization therapy (CRT) has proven efficacious in the treatment of patients with heart failure and dyssynchronous activation. Currently, we select suitable CRT candidates based on the QRS complex duration (QRSd) and morphology with left bundle branch block being the optimal substrate for resynchronization. To improve CRT response rates, recommendations emphasize attention to electrical parameters both before implant and after it. Therefore, we decided to study activation times before and after CRT on the body surface potential maps (BSPM) and to compare thus obtained results with data from electroanatomical mapping using the CARTO system. Total of 21 CRT recipients with symptomatic heart failure (NYHA II-IV), sinus rhythm, and QRSd ≥150 ms and 7 healthy controls were studied. The maximum QRSd and the longest and shortest activation times (ATmax and ATmin) were set in the BSPM maps and their locations on the chest were compared with CARTO derived time interval and site of the latest (LATmax) and earliest (LATmin) ventricular activation. In CRT patients, all these parameters were measured during both spontaneous rhythm and biventricular pacing (BVP) and compared with the findings during the spontaneous sinus rhythm in the healthy controls. QRSd was 169.7±12.1 ms during spontaneous rhythm in the CRT group and 104.3±10.2 ms after CRT (p<0.01). In the control group the QRSd was significantly shorter: 95.1±5.6 ms (p<0.01). There was a good correlation between LATmin(CARTO) and ATmin(BSPM). Both LATmin and ATmin were shorter in the control group (LATmin(CARTO) 24.8±7.1 ms and ATmin(BSPM) 29.6±11.3 ms, NS) than in CRT group (LATmin(CARTO) was 48.1±6.8 ms and ATmin(BSPM) 51.6±10.1 ms, NS). BVP produced shortening compared to the spontaneous rhythm of CRT recipients (LATmin(CARTO) 31.6±5.3 ms and ATmin(BSPM) 35.2±12.6 ms; p<0.01 spontaneous rhythm versus BVP). ATmax exhibited greater differences between both methods with higher values in BSPM: in the control group LATmax(CARTO) was 72.0±4.1 ms and ATmax (BSPM) 92.5±9.4 ms (p<0.01), in the CRT candidates LATmax(CARTO) reached only 106.1±6.8 ms whereas ATmax(BSPM) 146.0±12.1 ms (p<0.05), and BVP paced rhythm in CRT group produced improvement with LATmax(CARTO) 92.2±7.1 ms and ATmax(BSPM) 130.9±11.0 ms (p<0.01 before and during BVP). With regard to the propagation of ATmin and ATmax on the body surface, earliest activation projected most often frontally in all 3 groups, whereas projection of ATmax on the body surface was more variable. Our results suggest that compared to invasive electroanatomical mapping BSPM reflects well time of the earliest activation, however provides longer time-intervals for sites of late activation. Projection of both early and late activated regions of the heart on the body surface is more variable than expected, very likely due to changed LV geometry and interposed tissues between the heart and superficial ECG electrode.

scholarly journals Electrocardiographic Outcome of Resynchronization Therapy

2017 ◽  
pp. S523-S528 ◽  
Author(s):  
O. KITTNAR ◽  
L. RIEDLBAUCHOVÁ ◽  
J. TOMIS ◽  
M. LOŽEK ◽  
A. VALERIÁNOVÁ ◽  
...  
Keyword(s):  
Heart Failure ◽  
Biventricular Pacing ◽  
Left Ventricular ◽  
The Body ◽  
Ventricular Pacing ◽  
Resynchronization Therapy ◽  
Left Ventricular Pacing ◽  
Activation Times ◽  
The Impact ◽  
Spontaneous Rhythm

Cardiac resynchronization therapy (CRT) has proven efficacious in reducing or even eliminating cardiac dyssynchrony and thus improving heart failure symptoms. However, quantification of mechanical dyssynchrony is still difficult and identification of CRT candidates is currently based just on the morphology and width of the QRS complex. As standard 12-lead ECG brings only limited information about the pattern of ventricular activation, we aimed to study changes produced by different pacing modes on the body surface potential maps (BSPM). Total of 12 CRT recipients with symptomatic heart failure (NYHA II-IV), sinus rhythm and QRS width ≥120 ms and 12 healthy controls were studied. Mapping system Biosemi (123 unipolar electrodes) was used for BSPM acquisition. Maximum QRS duration, longest and shortest activation times (ATmax and ATmin) and dispersion of QT interval (QTd) were measured and/or calculated during spontaneous rhythm, single-site right- and left-ventricular pacing and biventricular pacing with ECHO-optimized AV delay. Moreover we studied the impact of CRT on the locations of the early and late activated regions of the heart. The average values during the spontaneous rhythm in the group of patients with dyssynchrony (QRS 140.5±10.6 ms, ATmax 128.1±10.1 ms, ATmin 31.8±6.7 ms and QTd 104.3±24.7 ms) significantly differed from those measured in the control group (QRS 93.0±10.0 ms, ATmax 79.1±3.2 ms, ATmin 24.4±1.6 ms and QTd 43.6±10.7 ms). Right ventricular pacing (RVP) improved significantly only ATmax [111.2±10.6 ms (p<0.05)] but no other measured parameters. Left ventricular pacing (LVP) succeeded in improvement of all parameters [QRS 105.1±8.0 ms (p<0.01), ATmax 103.7±7.1 ms (p<0.01), ATmin 20.2±3.7 ms (p<0.01) and QTd 52.0±9.4 ms (p<0.01)]. Biventricular pacing (BVP) showed also a beneficial effect in all parameters [QRS 121.3±8.9 ms (p<0.05), ATmax 114.3±8.2 ms (p<0.05), ATmin 22.0±4.1 ms (p<0.01) and QTd 49.8±10.0 ms (p<0.01)]. Our results proved beneficial outcome of LVP and BVP in evaluated parameters (what seems to be important particularly in the case of activation times) and revealed a complete return of activation times to normal distribution when using these CRT modalities.

scholarly journals Echocardiographic evaluation of ventricular septal defect haemodynamics

2007 ◽  
Vol 135 (9-10) ◽  
pp. 541-546
Author(s):  
Vesna Miranovic
Keyword(s):  
Ventricular Septal Defect ◽  
Pulmonary Artery ◽  
Body Surface ◽  
Septal Defect ◽  
Left Ventricular ◽  
The Body ◽  
Control Group ◽  
Healthy Children ◽  
And Control ◽  
The Relationship

Introduction Ventricular septal defect (VSD) is an opening in the interventricular septum. 30-50% of patients with congenital heart disease have VSD. Objective The aim of the study was to determine the dependence of the left ventricular diastolic dimension (LVD), left ventricular systolic dimension (LVS), shortening fraction (SF), left atrium (LA), pulmonary artery truncus (TPA) on the body surface and compare their values among experimental, control and a group of healthy children. Values of maximal systolic gradient pressure (Pvsd) of VSD were compared with children from one experimental and control group. Method Children were divided into three groups: experimental (32 children with VSD that were to go to surgery), control (20 children with VSD who did not require surgery) and 40 healthy children. Measurements of LVD, LVS, SF, LA, TPA were performed in accordance to recommendations of the American Echocardiographic Association. The value of Pvsd was calculated from the maximal flow velocity (V) in VSD using the following formula: Pvsd=4xV? (mm Hg). Results For children from the experimental group, the relationship between the body surface and the variability of the LVD was explained with 56.85%, LVS with 66.15%, SF with 4.9%, TPA with 58.92%. For children from the control group, the relationship between the body surface and the variability of LVD was explained with 88.8%, LVS with 72.5%, SF with 0.42%, PA with 58.92%. For healthy children, the relationship between the body surface and the variabilitiy of the LVD was explained with 88.8%, LVS with 88.78%, SF with 5.25% and PA with 84.75%. There was a significant statistical difference between average values of Pvsd in the experimental and control group (p<0.02). Conclusion The presence of the large VSD has an influence on the enlargement of LVD, LVS, SF, TPA. The enlargement of the size of the pulmonary artery depends on the presence of VSD and there is a direct variation in the magnitude of the shunt. There is a relationship and significant dependence of the LVS and LVD on the body surface. There is no statistically significant dependence between SF and body surface.

Anemia in Relation to Survival Following Thermal Injury in the Rat

1957 ◽  
Vol 189 (1) ◽  
pp. 6-10
Author(s):  
M. D. McCarthy ◽  
M. B. Amrein ◽  
M. Cobb ◽  
R. Neerhout ◽  
V. Blackburn
Keyword(s):  
Body Surface ◽  
Thermal Injury ◽  
The Body ◽  
Control Group ◽  
Base Line ◽  
Control Groups ◽  
Observation Period

Hematocrits, erythrocyte and reticulocyte counts were determined in rats receiving burns of 20%, 32% and 50% of the body surface and in three unburned control groups. All burned rats showed an immediate precipitous depression of hematocrits and erythrocyte counts. These were considerably lower at 24 hours postburn than the values in the control group which was bled. Erythrocyte depression during the 1st week postburn was directly related to extent of injury in the animals surviving for 24 weeks. No such correlation existed for those rats that died. No correlation was found between the immediate degree of anemia and death or survival. A secondary erythrocyte depression occurred in those animals that survived 24 weeks following burns of 32% and 50% of the body surface but did not develop in the 20% body surface burned animals surviving for 24 weeks. The erythrocyte counts in all control groups were above base line values at the end of the 24-week observation period. Elevated reticulocyte counts which were inversely related to the erythrocyte counts occurred in all burned animals surviving 24 weeks. The reticulocyte counts in all unburned groups were below base line at the end of the 24-week observation period.

scholarly journals Morphological changes in distant muscle fibers following thermal injury in Wistar rats

2010 ◽  
Vol 25 (6) ◽  
pp. 525-528 ◽  
Author(s):  
Flavia de Oliveira ◽  
Luci Rezende Bevilacqua ◽  
Carlos Alberto Anaruma ◽  
Silvia de Campos Boldrini ◽  
Edson Aparecido Liberti
Keyword(s):  
Body Surface ◽  
Wistar Rats ◽  
Thermal Injury ◽  
Morphological Changes ◽  
Muscle Fibers ◽  
The Body ◽  
Medial Gastrocnemius ◽  
Control Group ◽  
Hematoxylin And Eosin ◽  
Gastrocnemius Muscles

PURPOSE: Thermal injury causes catabolic processes as the body attempts to repair the damaged area. This study evaluated the effects of a scald injury on the morphology of muscle fibers belonging to a muscle distant from the lesion. METHODS: Thirty Wistar rats were divided into control (C) and scalded (S) groups. Group S was scalded over 45% of the body surface, standardized by body weight. Rats in both groups were euthanized at four, seven and 14 days following the injury. The middle portions of the medial gastrocnemius muscles were sectioned, stained with hematoxylin and eosin and Picrosirius, and submitted to histological analysis. RESULTS: Control group sections exhibited equidistantly distributed polygonal muscle fibers with peripheral nuclei, characteristic of normal muscle. The injured group sections did not consistently show these characteristics; many fibers in these sections exhibited a rounded contour, variable stain intensities, and greater interfiber distances. A substantially increased amount of connective tissue was also observed on the injured group sections. CONCLUSION: This experimental model found a morphological change in muscle distant from the site of thermal injury covering 45% of the body surface.

scholarly journals Advantage of Early Tangential Necrectomy in Extensive Pediatric Burns

2019 ◽  
Vol 3 (2) ◽  
Author(s):  
Kenan Karavdić
Keyword(s):  
Body Weight ◽  
Hospital Stay ◽  
Body Surface ◽  
The Body ◽  
Morbidity And Mortality ◽  
Control Group ◽  
Clinical Parameters ◽  
Laboratory Values ◽  
Pediatric Burns ◽  
Total Body

Background: An extensive burn is one of the most serious injuries. The modern treatment of pediatric burns is a logical exercise in resuscitation, infection control, surgical wound care, nutrition and psychologic and physical rehabilitation. The conventional methods of local therapy, especially in extensive and deep burns, cannot prevent infection. The fact is that the necrotic burn tissue always gives rise to infection and must therefore be excised. Tangential excision is a diagnostic procedure as well as a surgical preparation of a recipient bed for skin graft.  Clinical parameters of sixty extensively burned children have been evaluated, divided into two groups (surgically and non-surgically treated) and in four subgroups (under and over the 25% TBSA). The following criteria have been used to compare the results: pain, fever, body weight, duration of the hospital stay, wound infenction, laboratory values. Aim of research: The aim of our research was to demonstrate the efficacy of early tangential necrectomy in the treatment of extensive burns in children as well as in preventing the burn diseases. Material and methods: Clinical parameters of sixty extensively burned children have been evaluated, divided into two groups (surgically and non-surgically treated) and in four subgroups (under and over the 25% TBSA). The following criteria have been used to compare the results: pain, fever, body weight, duration of the hospital stay, wound infection, laboratory values. Results: The boys comprised 58.3% of the respondents and the girls were 41,7% of the respondents. The most common cause was the hot liquid of 73.3%, open flame 23.3% and the contact with hot metal 3.3%. The body temperature was significantly higher in control group compared to the examined group (p <0.001) significantly lower hematocrit values in the control group compared to the examined group (p = 0.002).      The results show that hospitalization lasted considerably longer in patients in the control group than in the examined group (p = 0.003). The incidence of bacterial infection of the burns is significantly higher in control compared to the examined group of patients (p = 0.007). The most commonly isolated bacteria in the study group was Staphylococcus aureus (15/30 or 50% of all subjects). Acinetobacter spp. was isolated in 9 patients (30% of respondents). Serratia spp. And Enterococcus Foecalis were isolated in 6 patients (20%). Pseudomonas aeruginosa was isolated in 3 patients (10%). Three patients (10%) did not isolate any bacteria during hospitalization Conclusions: The method of early tangential necrectomy of extensively burned children significantly reduce morbidity and mortality (it improves the general condition of the patient, improves clinical and laboratory parameters, reduces the possibility of infection of the wound, reduces the possibility of sepsis, reduces the length of hospitalization).The most optimal time to perform an early tangential necrectomy is the period between the 4th and the 6th day after the injury. In extensively burned children over 30% of the total body surface, an early tangential necrectomy should be performed on an area of about 20% of the total body surface as a prevention of blood loss due to necrectomy and autotransplantation. With extensively burned children over 40% of the total body surface, taking homotransplants from parents or close relatives reduces morbidity and mortality.

scholarly journals THE EFFECTIVENESS OF THE ELECTROMAGNETIC FIELD MATRIX TO THE WOUND HEALING PROCESS IN PARTIAL – THICKNESS BURNS

2020 ◽  
Vol 30 (6) ◽  
pp. 95-98
Author(s):  
Raminta Česnaitienė ◽  
Rytis Rimdeika
Keyword(s):  
Wound Healing ◽  
Treatment Period ◽  
Body Surface ◽  
Research Group ◽  
Standard Treatment ◽  
Healing Process ◽  
The Body ◽  
Control Group ◽  
Treatment Methods ◽  
Significant Difference

Burns are one of the most serious injuries, affecting around 11 million people a year worldwide. About 200/100000 inhabitants in Lithuania. Treatment is com­plex: the priorities of specialized facilities focus on sta­bilizing the patient, preventing infection, and optimizing functional recovery; and requires a lot of resources, both human and financial. Therefore, more and more effective treatments for burns are constantly being sought in order to accelerate the healing itself and thus reduce the du­ration of hospitalization. Number of recent reports sug­gests that EMF has a positive impact at different stages of healing. Processes impacted by EMF include, but are not limited to, cell migration and proliferation, expres­sion of growth factors, nitric oxide signaling, cytokine modulation, and more. Objectives and methods. The objective of this work was to study the effect of electromagnetic matrix on wound healing in burns. We evaluated medical records of 18 patients who underwent treatment in the department of plastic and reconstructive surgery from 2018.01.01 to 2019.12.30. All patients had IIA-IIB degree burns affec­ting less than 10% of the body surface and underwent the standard general treatment. They were divided into two groups: control group 55,6% (n=10) – treated only with the standard treatment and research group 44,4% (n=8) – to whom the EMF matrix were applied. Statistical data analysis was carried out using the SPSS 23.0 software. Results. Pain assessment, wound granulation area, and epithelialization were chosen to evaluate the burn healing process. These indicators were assessed on day 0-1; 3(±1) days and 7(±1) days after hospitalization. There was a statistically significant increase in wound granulation 5 days after the start of treatment in patients treated with the applicator (p = 0.019). Pain and epithelialization ra­tes between standard and applicator treatment methods did not differ statistically significantly over the treatment period. The partial nonparametric Spearman correlation coefficient, eliminating potentially influencing factors such as time after injury, the area of burn showed that the treatment method had a direct effect on the area of wound granulation (r = 0.625; p = 0.04). Conclusion. During the period from 2018.01.01 to 2019.12.31 patients had IIA-IIB degree burns affecting less than 10% of the body surface. 55,6 % of patients were treated only with the standard treatment and 44,4% with EMF matrix. The analysis showed that the average hospitalization time of the control group was 8.5 (0.898) days, while in the research group it was 7.88 (1.493) days, no statistically significant difference (p>0.05). There was a statistically significant increase in wound granulation 5 days after the start of treatment in patients treated with the applicator (p = 0.019). Pain and epitheli­alization rates between standard and applicator treatment methods did not differ statistically significantly over the treatment period.

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