Precautions and safety measures
Bipin Deshpande in Dermatologic Surgery with Radiofrequency, 2018
Cardiac pacemakers have an electric circuit (battery operated). Today’s pacemakers are far better protected from electrical cross circuits than a few decades back, yet it is always safe to avoid radiofrequency surgery in such patients. The radio waves travel through the body of the patient toward the antenna plate as mentioned on page 24, Figure 7.1, Chapter 7. These waves have the potential to affect the pacemaker function. Some practitioners advise either to keep the antenna plate far away from the vicinity of the pacemaker to avoid the radio waves disturbing the pacemaker circuit or delivering radiofrequency waves in bursts of less than 5 seconds to avoid the same problem. A prior consent from the patient’s cardiologist is a must before performing radiofrequency surgery for such patients. I prefer avoiding radiofrequency surgery in such patients. If needed, these patients can be safely treated with other modalities. I have included a statement in my informed consent forms that confirms the patient does not have a cardiac pacemaker. This form has to be duly signed separately for our safety.1–3 Refer to Chapter 11 for more information about the consent form.
Electrocardiography and arrhythmias
Neil Herring, David J. Paterson in Levick's Introduction to Cardiovascular Physiology, 2018
In Figure 5.4d, the atria (P waves) are beating at 88 bpm, driven by the sino-atrial (SA) node. The ventricles are beating at 53 bpm, driven by a latent pacemaker in the bundle of His or Purkinje system that has escaped from dominance by the SA node. Type II Mobitz second-degree heart block and complete heart block often cause problems. The slow heart rate that results can cause breathlessness, particularly on exertion when heart rate should rise. If QRS complexes cease for more than 3 s (as can occur intermittently in the latter two conditions), this compromises cerebral perfusion causing Stokes-Adams attacks (sudden, temporary loss of consciousness). Such patients are treated with implantable cardiac pacemakers. Complete cessation of ventricular electrical activity is known as “asystole” and will cause a cardiac arrest and sudden cardiac death unless cardiopulmonary resuscitation is started promptly.
Systemic Lupus Erythematosus
Vincenzo Berghella in Maternal-Fetal Evidence Based Guidelines, 2022
The risk of C-NLE is about 2% in mothers with positive anti-SSA or anti-SSA/SSB antibodies and no prior affected pregnancy. It increases to 10–15% if prior child with cutaneous lupus and 18% if prior child with cardiac–NL, but the risk does not decrease with a previously unaffected child. Anti-SSA or anti-SSA/SSB positive mothers with thyroid disease have a higher risk of NC-NLE as compared with mothers whose babies born in spring [108]. It is estimated that approximately 40% of patients with SLE have anti-Ro/SSA antibodies. C-NLE is most likely to occur between 18- and 24 weeks gestation and rarely after 26 weeks’ gestation [75, 80]. Third-degree AV block may be associated with congestive heart failure (hydrops), and in 18%, fetal or neonatal demise [77]. If third-degree AV block is associated with dilated cardiomyopathy, mortality is 50%. Poor prognostic factors in utero include diagnosis at <20 weeks’ gestation, hydrops, ventricular rate <50 bpm, left ventricular failure. A permanent cardiac pacemaker is needed in almost all survivors, and in 60–70% of affected children by 3 months of age [77]. In the current era, the 10-year survival rate of liveborns with normal cardiac function is 86% but falls to 23.1% if dilated cardiomyopathy is present at birth [109]. Cardiac transplant action occurs in 7–19% [98, 110].
Effects of mental imagery training combined electromyogram-triggered neuromuscular electrical stimulation on upper limb function and activities of daily living in patients with chronic stroke: a randomized controlled trial
Published in Disability and Rehabilitation, 2020
Seventy-nine participants were recruited from the local rehabilitation hospital in Korea. Among all the participants, 68 participants were finally selected as study subjects (Figure 1). The inclusion and exclusion criteria were derived from a previous study [13–17]. The inclusion criteria for the participants were as follows: (a) the participants with a first-time cerebral infarction or cerebral hemorrhage which had been ascertained by computer tomography or magnetic resonance imaging for at least 6 months, (b) the participants who were able to have an active wrist extension at least 10°, (c) Modified Ashworth Scale (MAS) grade on the muscles affecting on the wrist and fingers of affected upper limb ≤ 2, (d) intact general cognitive function as determined by the Korean version of Mini-Mental Examination score ≥ 24, and (e) a normal movement imagery ability as confirmed by the Vividness of Movement Imagery Questionnaire (VMIQ) average score ≤ 2.26. The exclusion criteria were as follows: (a) the participant with artificial cardiac pacemaker, (b) Medical Research Council (MRC) grade on the affected upper limb is 0, (c) the affected upper limb pain determined Visual Analogue Scale ≥ 5, and (d) the participant with skin lesions on the electrodes.
Treatment of ATTR cardiomyopathy with a TTR specific antisense oligonucleotide, inotersen
Published in Amyloid, 2019
Noel R. Dasgupta, Merrill D. Benson
Efficacy data are summarized using descriptive statistics as this is an uncontrolled study. As of January 2018, eight male ATTRm patients with an average age of 63.3 years at entry and seven male ATTRWT patients with an average age of 74.1 years at entry completed 2 years. TTR reduction, while prompt and sustained, did not correlate with apparent clinical efficacy. Compared to historical untreated patients, in this study most patients had stabilization or improvement of their cardiomyopathy. A 0.54 and 8.5% reduction in LVM was seen at 12 and 24 months, respectively, in ATTRm and ATTRWT patients (Figure 1). Interventricular septal thickness remained stable in three of 15 patients and decreased in 12 of 15 patients. LVEF increased or remained stable in most subjects. Left ventricular longitudinal systolic strain varied with treatment for heart failure. In six of eight hereditary patients, 6MWT distance increased with a mean improvement from baseline of 29 m at 12 months to 41 m at 24 months of treatment (Figure 1). 6MWT distance varied in ATTRWT patients. NYHA class remained stable in 10 of 15 patients, improved in three of 15 patients and deteriorated in two of 15 patients. BNP did not worsen throughout the study. Several patients required cardiac pacemakers prior to or after study entry with the main requirement dictated by atrioventricular (AV) block.
Autonomic dysregulation in colon cancer patients
Published in Cancer Investigation, 2018
Aneta L. Zygulska, Agata Furgala, Krzysztof Krzemieniecki, Beata Wlodarczyk, Piotr Thor
The study was conducted at the Department of Oncology of the University Hospital and at the Department of Pathophysiology in Cracow (Poland) between September 2014 and September 2015. The protocol of the study was approved by the Local Bioethics Committee (opinion no. KBET/98/B/2014), and written informed consent was sought from all the subjects prior to any procedure. All procedures were compliant with the Declaration of Helsinki. A total of 30 patients with histologically confirmed colonic adenocarcinoma (8 men and 22 women) and 30 healthy controls (8 men and 22 women) were enrolled. The presence of implanted cardiac pacemakers and treatment with medications modulating the activity of autonomic or central nervous system were exclusion criteria from the study. Mean age of colon cancer patients and controls was 64.8 ± 10.2 years (range 40-85) and 64.2 ± 12.3 years (range 35–80), respectively. Body mass index (BMI) and body surface area (BSA) were not significant different in the cancer patients group and in the control group. BMI and BSA were 27.7 ± 5.02 vs. 26.8 ± 3.8[kg/m2] and 1.85 ± 0.17 vs. 1.81 ± 0.2[m2], respectively.
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