AM Mauro - Academia.edu (original) (raw)

Papers by AM Mauro

Archives of Internal Medicine, 1989

We evaluated the early clinical performance of an implantable cardioverter/defibrillator with a n... more We evaluated the early clinical performance of an implantable cardioverter/defibrillator with a nonepicardial lead system in patients with refractory ventricular tachycardia or ventricular fibrillation. Ten patients, mean age 67 years, mean left ventricular ejection fraction 35%, refractory to 5 +/- 2 antiarrhythmic drugs and with a history of prior cardiac surgery (7 patients), severe lung disease (2 patients), or renal failure (1 patient) underwent device and lead system implant. A tripolar electrode catheter with one sensing electrode and two defibrillating electrodes was placed in the right ventricular apex and a left thoracic submuscular patch electrode was used in an epicostal location. Defibrillation energy threshold was determined using dual- or triple-electrode configurations. Optimal patch electrode location was determined after temporary use of a cutaneous patch electrode prior to cardioverter/defibrillator implant. Electrophysiologic studies were performed before discharge and after 2 to 3 months to assess device function. Percutaneous insertion and placement of the electrode catheter was achieved in all patients. Defibrillation energy threshold testing was done using 1 to 4 (mean, 2.7) electrode configurations per patient and required 6 to 21 (mean, 13) ventricular fibrillation inductions and 8 to 56 (mean, 22) shocks per patient. In all patients, lowest reliable defibrillation energy threshold was obtained with a triple-electrode configuration (right ventricular common cathode with right atrial and thoracic patch as dual anodes) and bidirectional shocks (mean, 18 +/- 5 J). Optimal patch electrode position could be determined in 9 of 10 patients, and these 9 patients had cardioverter/defibrillator implant. Ventricular fibrillation termination with the first delivered shock at electrophysiologic study was documented in all patients. There was no perioperative mortality in device-implanted patients. Postoperative electrophysiologic studies before discharge (9 patients) and at 3 months (8 patients) continued to demonstrate successful defibrillation by the first device shock. During follow-up (range, 2 to 10 months; mean, 6 +/- 3 months), spontaneous device discharges occurred in 4 patients with inappropriate shocks due to electrode catheter fracture being documented in 1 patient. Antiarrhythmic drug therapy was withdrawn in 6 patients and reduced in 3 patients. We conclude, based on our preliminary experience, that an implantable cardioverter/defibrillator can be successfully used with a nonepicardial lead system for endocardial defibrillation in many patients. This lead system can be used with currently available pulse generators and should be considered at cardioverter/defibrillator implantation. It can be anticipated to reduce patient risk and hospital costs associated with this procedure.

The American Journal of Cardiology, 1990

Heart & lung : the journal of critical care, 1988

The purpose of this study was to determine the effects of using the bell versus the diaphragm of ... more The purpose of this study was to determine the effects of using the bell versus the diaphragm of the stethoscope on indirect blood pressure (BP) measurement. The design was experimental. Data were collected from 56 subjects randomly selected from 255 young women. Systolic (S1), fourth phase diastolic (D4), and fifth phase diastolic (D5) values were the dependent variables. Three research hypotheses were tested. Data were analyzed by using a one-tailed t test for dependent means. Hypotheses 1 and 2 predicted that use of the bell would result in higher S1 and D4 readings, respectively, than use of the diaphragm. Hypothesis 1 was supported whereas hypothesis 2 was not. Hypothesis 3, which stated that using the bell would produce a lower D5 reading than using the diaphragm, was supported. Implications of these findings as well as suggestions for future research are discussed.

Archives of Internal Medicine, 1989

We evaluated the early clinical performance of an implantable cardioverter/defibrillator with a n... more We evaluated the early clinical performance of an implantable cardioverter/defibrillator with a nonepicardial lead system in patients with refractory ventricular tachycardia or ventricular fibrillation. Ten patients, mean age 67 years, mean left ventricular ejection fraction 35%, refractory to 5 +/- 2 antiarrhythmic drugs and with a history of prior cardiac surgery (7 patients), severe lung disease (2 patients), or renal failure (1 patient) underwent device and lead system implant. A tripolar electrode catheter with one sensing electrode and two defibrillating electrodes was placed in the right ventricular apex and a left thoracic submuscular patch electrode was used in an epicostal location. Defibrillation energy threshold was determined using dual- or triple-electrode configurations. Optimal patch electrode location was determined after temporary use of a cutaneous patch electrode prior to cardioverter/defibrillator implant. Electrophysiologic studies were performed before discharge and after 2 to 3 months to assess device function. Percutaneous insertion and placement of the electrode catheter was achieved in all patients. Defibrillation energy threshold testing was done using 1 to 4 (mean, 2.7) electrode configurations per patient and required 6 to 21 (mean, 13) ventricular fibrillation inductions and 8 to 56 (mean, 22) shocks per patient. In all patients, lowest reliable defibrillation energy threshold was obtained with a triple-electrode configuration (right ventricular common cathode with right atrial and thoracic patch as dual anodes) and bidirectional shocks (mean, 18 +/- 5 J). Optimal patch electrode position could be determined in 9 of 10 patients, and these 9 patients had cardioverter/defibrillator implant. Ventricular fibrillation termination with the first delivered shock at electrophysiologic study was documented in all patients. There was no perioperative mortality in device-implanted patients. Postoperative electrophysiologic studies before discharge (9 patients) and at 3 months (8 patients) continued to demonstrate successful defibrillation by the first device shock. During follow-up (range, 2 to 10 months; mean, 6 +/- 3 months), spontaneous device discharges occurred in 4 patients with inappropriate shocks due to electrode catheter fracture being documented in 1 patient. Antiarrhythmic drug therapy was withdrawn in 6 patients and reduced in 3 patients. We conclude, based on our preliminary experience, that an implantable cardioverter/defibrillator can be successfully used with a nonepicardial lead system for endocardial defibrillation in many patients. This lead system can be used with currently available pulse generators and should be considered at cardioverter/defibrillator implantation. It can be anticipated to reduce patient risk and hospital costs associated with this procedure.

The American Journal of Cardiology, 1990

Heart & lung : the journal of critical care, 1988

The purpose of this study was to determine the effects of using the bell versus the diaphragm of ... more The purpose of this study was to determine the effects of using the bell versus the diaphragm of the stethoscope on indirect blood pressure (BP) measurement. The design was experimental. Data were collected from 56 subjects randomly selected from 255 young women. Systolic (S1), fourth phase diastolic (D4), and fifth phase diastolic (D5) values were the dependent variables. Three research hypotheses were tested. Data were analyzed by using a one-tailed t test for dependent means. Hypotheses 1 and 2 predicted that use of the bell would result in higher S1 and D4 readings, respectively, than use of the diaphragm. Hypothesis 1 was supported whereas hypothesis 2 was not. Hypothesis 3, which stated that using the bell would produce a lower D5 reading than using the diaphragm, was supported. Implications of these findings as well as suggestions for future research are discussed.