Richard Luceri - Academia.edu (original) (raw)
Papers by Richard Luceri
Non-Firearm Temporal Officer-Associated Death Incident Features Checklist, 2024
Checklist: Brave, M., Kroll, M.W., Ross, D.L., Kunz, S.N., Peters, Jr., J.G., Luceri, R.M., Karch... more Checklist: Brave, M., Kroll, M.W., Ross, D.L., Kunz, S.N., Peters, Jr., J.G., Luceri, R.M., Karch, S., Vilke G.M., Bloodgood, M., Park, P., Wetli, C., and Mash, D. (2024). Non-Firearm Temporal Officer-Associated Death Incident Features Checklist. 20 May 2024. [DOI: 10.13140/RG.2.2.16084.62081]
Cardiology Clinics, Feb 1, 1985
The development of implantable devices for the treatment of tachyarrhythmias has resulted in addi... more The development of implantable devices for the treatment of tachyarrhythmias has resulted in additional therapeutic choices for the affected patients. Technologic advances now permit one to choose from a wide variety of devices capable of intervening automatically in the presence of supraventricular or ventricular arrhythmias. Although all methods remain in the investigational stage at this time, sufficient evidence has been gathered to support the efficacy of certain devices in the presence of various arrhythmias. Pacemaker-energy pulses may be delivered in various sequences to interrupt re-entrant rhythms, and their reproducible success can be effectively demonstrated in the electrophysiology laboratory. Cardioverting and defibrillating devices are capable of recognizing and successfully interrupting malignant ventricular arrhythmias. The automatic defibrillator has already been reported to reduce 1-year arrhythmic mortality in high-risk patients. Although still in the infant stages of development, the continuing advances in device technology suggest that their future applications are indeed promising.
American Heart Journal, Apr 1, 1976
PubMed, 1979
The urinary tract visualized on plain abdominal film 10 min after angiocardiography revealed 49 a... more The urinary tract visualized on plain abdominal film 10 min after angiocardiography revealed 49 abnormalities of the urinary tract in 680 patients with congenital heart disease (7.2%). The diagnostic value is high, as among the 49 abnormalities 40.9% had no urinary symptoms. 5 abnormalities of the urinary tract required rapid surgical treatment.
PubMed, Feb 1, 1996
The implantable cardioverter defibrillator has revolutionized the management of lethal ventricula... more The implantable cardioverter defibrillator has revolutionized the management of lethal ventricular arrhythmias in susceptible patients. In its second decade of existence, the implantable cardioverter defibrillator has undergone significant technologic enhancements which have resulted in ease of implantation, lower mortality rates, and shorter hospital stays. The newer pectoral size devices have been successfully implanted in a variety of patients, using models from several device manufacturers. Improvements in lead technology have paralleled those of the device itself. These include the unique concept of "unipolar" defibrillation as well as the trend toward dual chamber lead systems. Results of these newer technologies are favorable: comparably low defibrillation thresholds have been reported with the newer lead configurations, with lower operative mortality. However, morbidity attached to earlier lead systems remains as high as 16%. It is anticipated that the results will further improve as shorter transvenous leads and better connector material become routinely available. Finally, the clinical outcomes in the early postoperative phase indicate fewer proarrhythmic effects leading to shorter hospital stays in patient equipped with the latest types of pectoral implants. Continued progress at the level of the patient-device interface is expected to result in every better patient acceptance and proliferation of implantable cardioverter defibrillator therapy.
Chest, Jul 1, 1985
The text has little to say about streptokinase therapy and coronary angioplasty. Given the extens... more The text has little to say about streptokinase therapy and coronary angioplasty. Given the extensive use of these procedures. those of us in practice could use some guidelines. This book would be ideal in a cardiac pathophysiology course for medical students or cardiology fellows. The clinician will find it a valuable bridge between the laboratory and his patients.
Pacing and Clinical Electrophysiology, Nov 1, 1984
La surveillance des stimulateurs DDD. La surveillance des pacemakers DDD est devenue de plus en p... more La surveillance des stimulateurs DDD. La surveillance des pacemakers DDD est devenue de plus en plus difficile d cause de la compJexite croissante des generateurs d'impuJsion. L/n "test type" devrait etre d^velopp^ pour permettre une analyse systematique et I'enregistrement des donnees. Pour suivre e^icacement un patient porteur d'un pacemaker DDD il est necessaire de connaitre son rythme sousjacent celeri du generateur d'impulsion, Ia soupJesse de sa programmation et ses autres particuJarites. LUCERI, R.M., HAYES, D.L.: Follow-up of DDD pacemakers. With the increasing complexity of DDD pacemakers, follow-up of these pulse generators iias aiso become more complex. A pattern for testing DDD pacemakers shouJd be deveJoped, the patient should be taken through these pacing sequences in a systematic way, and the values shouid be recorded. To adequately/oliow-up the patient with a DDD pacemaker, one must know the patient and his underlying rhythm, the pulse generator and its programmable /Jexibiiity, and any peculiarities of the particular pulse generator.
Clinical progress in pacing and electrophysiology, Jun 1, 1983
Journal of Cardiovascular Electrophysiology, Jun 28, 2008
In December, 1987, Dr. Michael Bilitch died after a one-year struggle with cancer. Dr. Bilitch wa... more In December, 1987, Dr. Michael Bilitch died after a one-year struggle with cancer. Dr. Bilitch was an Associate Professor on the Cardiology faculty at the University of Southern California in Los Angeles. His primary interest was in the field of cardiac pacing which, among other endeavors, consumed most of his professional life. This passion for cardiac stimulation spanned a full quarter of a century, and he was counted among the founders of the North American Society of Pacing and Electrophysiology (NASPE), and of the International Cardiac Pacing and Electrophysiology Society (lCPES). Indeed, at the time of his death. Dr. Bilitch was the President of NASPE and was actively involved in planning the 1991 World Symposium of the ICPES as its Secretary General. Michael Bilitch made significant contributions to the literature of cardiac pacing and was a member of the Editorial Boards of PACE and the Journal of Electrophysiology since their inception. He was a respected teacher of clinical medicine and a perennial favorite at seminars and teaching conferences. His colleagues and friends deeply mourn his passing and extend their deepest condolences to his family.
American Heart Journal, Sep 1, 1978
Journal of the American College of Cardiology, Aug 1, 1996
Objectives. The effects of propafenone, a predominantly class IC antiarrhythmic drug, on defibril... more Objectives. The effects of propafenone, a predominantly class IC antiarrhythmic drug, on defibrillation and pacing thresholds were evaluated in patients undergoing cardioverter-defibrillator implantation. Background. Previous studies have shown that the class IC agents encainide and flecainide may increase the energy requirements for pacing and defibrillation. Animal studies with propafenone have shown inconsistent results regarding its effect on defibrillation energy requirements. This report investigated the effects of propafenone on defibrillation and pacing thresholds in humans. Methods. After cardioverter-defibrillator implantation, 47 patients were enrolled in a double-blind, three-way parallel, randomized trial of 450 mg/day (Group 1) or 675 rag/day (Group 2) of oral propafenone or placebo (Group 3) for 3 to 7 days. Predischarge defibrillation and pacing thresholds after treatment were compared with baseline thresholds obtained at implantation. Results. There was no statistically significant difference between implantation and predischarge defibrillation thresholds in the three groups (Group 1: [mean-+ SE] 11.0 + 1.3 vs. 12.1-+ 1.5 J; Group 2:11.5 + 1.1 vs. 13.6-+ 1.3 J; Group 3:12.5-+ 1.2 vs. 13.3 + 1.6 J), and no significant difference between treatment groups was found with a 0.86 power to detect a 5-J difference between groups. Paired pulse width pacing thresholds at 2.8 V were compared in 14 patients. A small increase of 0.02 ms was noted at predischarge testing in patients treated with propafenone and placebo. Conclusions. Short-term oral propafenone (450 and 675 rag/day) does not significantly affect defibrillation or pacing thresholds. Concomitant use of propafenone in patients with implantable cardioverter-defibriHators with recurrent ventricular or atrial tachyarrhythmias should not interfere with proper device function.
Europace, 2001
The aim of this study was to compare athal defibrillation thresholds (ADFT) for refractory perman... more The aim of this study was to compare athal defibrillation thresholds (ADFT) for refractory permanent atrial fibrigation (AF) between the new Physio-Contml LifePek 12 3D (PC) bipheeic defibdlletor and the Vent~ex HVS-02 (I-IV} using transvenous low energy shocks.
Circulation, 2013
The TASER International's Scientific Medical Advisory Board read with interest the medical expert... more The TASER International's Scientific Medical Advisory Board read with interest the medical expert series from Dr Zipes. 1 Complete, balanced, and impartial medical expert testimony are important contributors to advancing medical science. In this series, we believe that Dr Zipes missed or disregarded crucial information. Cases 4 and 5 are examples; there are others. In case 4, video, acoustic, forensic, and probe analysis indicate no contact made between the TASER probe and the suspect's chest. The emergency medical technician paramedic present documented and testified under oath that both pulse and respirations were present for >8 minutes after electronic control device (ECD) deployment. 2 Dr Zipes, as an expert witness in this case, either missed or disregarded this information. For case 5, every medical personnel interpreted all of the rhythm strips (3 cardiac rhythm strips by emergency medical services personnel and 1 by an emergency medical physician) as asystole, whereas Dr Zipes chose fine ventricular fibrillation (personal communication with Michael Brave and Rich versus Taser Testimony, Taser International, May 28, 2012). ECD safety has been demonstrated in large, independent epidemiological studies, 3 and studies show ECDs reduce suspect injuries by approximately two thirds. 4 Approximately 3 million ECD applications have occurred worldwide (personal communication with S Tuttle, TASER International, May 28, 2012). We believe that the case series from Dr Zipes must be put into context. Even assuming arguendo that these deaths were ECD caused, which we do not agree with, these must be compared with the ≈80 000 lethal force uses avoided by 1 600 000 ECD applications. 5 In comparison, cardiac electrophysiologists warn patients that routine procedures have mortality risks of ≥1:10 000. ECD use is not risk free. Practice advances, in medicine or law enforcement, always have potential complication rates. Since January 2005, TASER's training materials have included the Pacing and Clinical Electrophysiology (PACE) study's conclusions that, "[t]he safety index for an [ECD] discharge was shown to have a significant and positive association to weight. Discharge levels for standard electric [ECDs] have an extremely low probability of inducing [ventricular fibrillation]." As Dr Zipes notes, in 2009 TASER recommended avoidance of ECD chest deployments if possible. The caveat "if possible" is crucial because officers do not always have the luxury to accurately aim during dynamic confrontations. TASER proactively made the conservative recommendation without definite data support because of public concerns that ECDs might have a cardiac effect, albeit miniscule. We are committed to continuous improvement and product safety.
Circulation, Oct 1, 1983
Iti an 18-year-old patient without manifest or concealed Wolff-Parkinson-White syndrome, spontane... more Iti an 18-year-old patient without manifest or concealed Wolff-Parkinson-White syndrome, spontaneous and paced left atrial impulses penetrated a left-sided AV nodal input and thereafter activated the ventricles in a normal fashion exclusively through the His-Purkinje system. On the other hand, sinus and paced right atrial impulses entered a right-sided atrioventricular nodal input that was completely dissociated from the left-sided input to subsequently activate the ventricles partly through Mahaim fibers and partly through the His-Purkinje system. The Mahaim fibers, which acted as "bystanders" during episodes of atrioventricular nodal reciprocating tachycardia, seemed to have extended from a "distal," common (right-sided) intranodal pathway (or "proximal" His bundle) to the right ventricle or, although this is less likely, to the right bundle branch. More studies are necessary to determine whether the association on the surface electrocardiogram of an ectopic slow left atrial rhythm with changes in QRS morphology (but not in QRS duration) always reflects the existence of Mahaim fibers.
PubMed, May 1, 1979
Our case of azygos continuation of the inferior vena cava is very rare because there was no assoc... more Our case of azygos continuation of the inferior vena cava is very rare because there was no associated heart disease or abdominal situs inversus. The diagnosis of this anomaly of the inferior vena cava should be suspected by observation of a dilated azygos vein on the chest roentgenogram and confirmed by venography.
Pacing and Clinical Electrophysiology, Feb 1, 1997
Pacing and Clinical Electrophysiology, 1999
of System Performance in ICD Patients Without Spontaneous Shocks. One hundred five implantable ca... more of System Performance in ICD Patients Without Spontaneous Shocks. One hundred five implantable cardioverter defibrillator (ICD) patients (71 ± 9 years of age, 83% men) without spontaneous ICD discharges for ^12 months were tested to assess high voltage (HV) circuit integrity and the system's ability to recognize and terminate ventricular fibrillation (VF). Indications for ICD implantation were sustained ventricular tachycardia (VT) (35%), cardiac arrest (27%), and inducible VT (38%). Eighty-two percent ofthe patients had coronary artery disease (CAD), and the mean left ventricular ejection fraction (LVEF) was 36% ± 13%. Results: One hundred patients had inducible VF and five did not. Testing led to ICD reprogramming in 50 (49%) patients. Two (1.9%) patients required ICD replacement: (1) a 45-year-old patient with a Ventritex 110 ICD implanted for 13 months interfaced with a CPI 0062 lead implanted for 46 months could not be defibrillated internally (impedance nonmeasurable); (2) an 82-yearold patient with a 23-month-old Medtronic 7219 ICD interfaced with 6936 and 6933 leads whose defibrillation threshold (DFT) had doubled since implantation (24 Jfrom 12 J). Lead fractures were found in both cases (proximal coil ofthe 0062, and subcutaneously in the 6933). Based on DFT determinations, the first shock output was programmed lower in 37 patients and higher in 10 patients. Shock pulse width was changed in one patient and the ventricular refractory period in another. No programming changes were made in 54 (51 %) patients. Conclusions: (1) Late testing ofHV circuit integrity in ICD patients without an ICD shock in s 12 months identifies previously unsuspected HV lead fractures; (2) chronic DFT testing resulted in HV output reprogramming in one-half of the patients.
American Journal of Cardiology, Aug 1, 1984
Annihilation and one-to-one entrainment of modulated parasystolic rhythms in humans has not been ... more Annihilation and one-to-one entrainment of modulated parasystolic rhythms in humans has not been previously discussed. In 9 nonmedicated patients, it was possible to measure the intrinsic, parasystolic ectopic cycle length given by the intervals between 2 consecutive parasystolic beats without any interposed nonparasystolic beat. The corresponding values varied between 960 and 2,350 ms (corresponding to rates between 62 and 26 beats/min). In addition, modulation could be determined, because nonparasystolic beats falling during the initial 59% of the cycle prolonged the parasystolic cycle length (by 12 to 37.5%), whereas those that fell later in the cycle shortened it (by 9 to 25%). Plotting this prolongation or shortening as a function of the temporal position of the nonparasystolic beats in the cycle yielded biphasic response curves, of which 7 were symmetric and 2 asymmetric. In 2 patients, episodes of concealed one-to-one entrainment were initiated by late nonparasystolic (sinus) beats and, later on, terminated by early ventricular extrasystoles. In 2 other patients (and in 2 separate occasions) nonparasystolic beats, falling in part of the cycle located in between those of maximal delay and acceleration, produced pacemaker annihilation (cessation of automatic activity for the remaining monitoring time). Parasystolic annihilation and concealed entrainment may be one of the causes that can explain the large, spontaneous, day-to-day variability in the incidence of ectopic ventricular beats reported in Holter recordings. Nevertheless, future prospective studies performing interventions that can change the sinus and ectopic rates are required to corroborate our finding.
Pacing and Clinical Electrophysiology, Dec 1, 1990
Non-Firearm Temporal Officer-Associated Death Incident Features Checklist, 2024
Checklist: Brave, M., Kroll, M.W., Ross, D.L., Kunz, S.N., Peters, Jr., J.G., Luceri, R.M., Karch... more Checklist: Brave, M., Kroll, M.W., Ross, D.L., Kunz, S.N., Peters, Jr., J.G., Luceri, R.M., Karch, S., Vilke G.M., Bloodgood, M., Park, P., Wetli, C., and Mash, D. (2024). Non-Firearm Temporal Officer-Associated Death Incident Features Checklist. 20 May 2024. [DOI: 10.13140/RG.2.2.16084.62081]
Cardiology Clinics, Feb 1, 1985
The development of implantable devices for the treatment of tachyarrhythmias has resulted in addi... more The development of implantable devices for the treatment of tachyarrhythmias has resulted in additional therapeutic choices for the affected patients. Technologic advances now permit one to choose from a wide variety of devices capable of intervening automatically in the presence of supraventricular or ventricular arrhythmias. Although all methods remain in the investigational stage at this time, sufficient evidence has been gathered to support the efficacy of certain devices in the presence of various arrhythmias. Pacemaker-energy pulses may be delivered in various sequences to interrupt re-entrant rhythms, and their reproducible success can be effectively demonstrated in the electrophysiology laboratory. Cardioverting and defibrillating devices are capable of recognizing and successfully interrupting malignant ventricular arrhythmias. The automatic defibrillator has already been reported to reduce 1-year arrhythmic mortality in high-risk patients. Although still in the infant stages of development, the continuing advances in device technology suggest that their future applications are indeed promising.
American Heart Journal, Apr 1, 1976
PubMed, 1979
The urinary tract visualized on plain abdominal film 10 min after angiocardiography revealed 49 a... more The urinary tract visualized on plain abdominal film 10 min after angiocardiography revealed 49 abnormalities of the urinary tract in 680 patients with congenital heart disease (7.2%). The diagnostic value is high, as among the 49 abnormalities 40.9% had no urinary symptoms. 5 abnormalities of the urinary tract required rapid surgical treatment.
PubMed, Feb 1, 1996
The implantable cardioverter defibrillator has revolutionized the management of lethal ventricula... more The implantable cardioverter defibrillator has revolutionized the management of lethal ventricular arrhythmias in susceptible patients. In its second decade of existence, the implantable cardioverter defibrillator has undergone significant technologic enhancements which have resulted in ease of implantation, lower mortality rates, and shorter hospital stays. The newer pectoral size devices have been successfully implanted in a variety of patients, using models from several device manufacturers. Improvements in lead technology have paralleled those of the device itself. These include the unique concept of "unipolar" defibrillation as well as the trend toward dual chamber lead systems. Results of these newer technologies are favorable: comparably low defibrillation thresholds have been reported with the newer lead configurations, with lower operative mortality. However, morbidity attached to earlier lead systems remains as high as 16%. It is anticipated that the results will further improve as shorter transvenous leads and better connector material become routinely available. Finally, the clinical outcomes in the early postoperative phase indicate fewer proarrhythmic effects leading to shorter hospital stays in patient equipped with the latest types of pectoral implants. Continued progress at the level of the patient-device interface is expected to result in every better patient acceptance and proliferation of implantable cardioverter defibrillator therapy.
Chest, Jul 1, 1985
The text has little to say about streptokinase therapy and coronary angioplasty. Given the extens... more The text has little to say about streptokinase therapy and coronary angioplasty. Given the extensive use of these procedures. those of us in practice could use some guidelines. This book would be ideal in a cardiac pathophysiology course for medical students or cardiology fellows. The clinician will find it a valuable bridge between the laboratory and his patients.
Pacing and Clinical Electrophysiology, Nov 1, 1984
La surveillance des stimulateurs DDD. La surveillance des pacemakers DDD est devenue de plus en p... more La surveillance des stimulateurs DDD. La surveillance des pacemakers DDD est devenue de plus en plus difficile d cause de la compJexite croissante des generateurs d'impuJsion. L/n "test type" devrait etre d^velopp^ pour permettre une analyse systematique et I'enregistrement des donnees. Pour suivre e^icacement un patient porteur d'un pacemaker DDD il est necessaire de connaitre son rythme sousjacent celeri du generateur d'impulsion, Ia soupJesse de sa programmation et ses autres particuJarites. LUCERI, R.M., HAYES, D.L.: Follow-up of DDD pacemakers. With the increasing complexity of DDD pacemakers, follow-up of these pulse generators iias aiso become more complex. A pattern for testing DDD pacemakers shouJd be deveJoped, the patient should be taken through these pacing sequences in a systematic way, and the values shouid be recorded. To adequately/oliow-up the patient with a DDD pacemaker, one must know the patient and his underlying rhythm, the pulse generator and its programmable /Jexibiiity, and any peculiarities of the particular pulse generator.
Clinical progress in pacing and electrophysiology, Jun 1, 1983
Journal of Cardiovascular Electrophysiology, Jun 28, 2008
In December, 1987, Dr. Michael Bilitch died after a one-year struggle with cancer. Dr. Bilitch wa... more In December, 1987, Dr. Michael Bilitch died after a one-year struggle with cancer. Dr. Bilitch was an Associate Professor on the Cardiology faculty at the University of Southern California in Los Angeles. His primary interest was in the field of cardiac pacing which, among other endeavors, consumed most of his professional life. This passion for cardiac stimulation spanned a full quarter of a century, and he was counted among the founders of the North American Society of Pacing and Electrophysiology (NASPE), and of the International Cardiac Pacing and Electrophysiology Society (lCPES). Indeed, at the time of his death. Dr. Bilitch was the President of NASPE and was actively involved in planning the 1991 World Symposium of the ICPES as its Secretary General. Michael Bilitch made significant contributions to the literature of cardiac pacing and was a member of the Editorial Boards of PACE and the Journal of Electrophysiology since their inception. He was a respected teacher of clinical medicine and a perennial favorite at seminars and teaching conferences. His colleagues and friends deeply mourn his passing and extend their deepest condolences to his family.
American Heart Journal, Sep 1, 1978
Journal of the American College of Cardiology, Aug 1, 1996
Objectives. The effects of propafenone, a predominantly class IC antiarrhythmic drug, on defibril... more Objectives. The effects of propafenone, a predominantly class IC antiarrhythmic drug, on defibrillation and pacing thresholds were evaluated in patients undergoing cardioverter-defibrillator implantation. Background. Previous studies have shown that the class IC agents encainide and flecainide may increase the energy requirements for pacing and defibrillation. Animal studies with propafenone have shown inconsistent results regarding its effect on defibrillation energy requirements. This report investigated the effects of propafenone on defibrillation and pacing thresholds in humans. Methods. After cardioverter-defibrillator implantation, 47 patients were enrolled in a double-blind, three-way parallel, randomized trial of 450 mg/day (Group 1) or 675 rag/day (Group 2) of oral propafenone or placebo (Group 3) for 3 to 7 days. Predischarge defibrillation and pacing thresholds after treatment were compared with baseline thresholds obtained at implantation. Results. There was no statistically significant difference between implantation and predischarge defibrillation thresholds in the three groups (Group 1: [mean-+ SE] 11.0 + 1.3 vs. 12.1-+ 1.5 J; Group 2:11.5 + 1.1 vs. 13.6-+ 1.3 J; Group 3:12.5-+ 1.2 vs. 13.3 + 1.6 J), and no significant difference between treatment groups was found with a 0.86 power to detect a 5-J difference between groups. Paired pulse width pacing thresholds at 2.8 V were compared in 14 patients. A small increase of 0.02 ms was noted at predischarge testing in patients treated with propafenone and placebo. Conclusions. Short-term oral propafenone (450 and 675 rag/day) does not significantly affect defibrillation or pacing thresholds. Concomitant use of propafenone in patients with implantable cardioverter-defibriHators with recurrent ventricular or atrial tachyarrhythmias should not interfere with proper device function.
Europace, 2001
The aim of this study was to compare athal defibrillation thresholds (ADFT) for refractory perman... more The aim of this study was to compare athal defibrillation thresholds (ADFT) for refractory permanent atrial fibrigation (AF) between the new Physio-Contml LifePek 12 3D (PC) bipheeic defibdlletor and the Vent~ex HVS-02 (I-IV} using transvenous low energy shocks.
Circulation, 2013
The TASER International's Scientific Medical Advisory Board read with interest the medical expert... more The TASER International's Scientific Medical Advisory Board read with interest the medical expert series from Dr Zipes. 1 Complete, balanced, and impartial medical expert testimony are important contributors to advancing medical science. In this series, we believe that Dr Zipes missed or disregarded crucial information. Cases 4 and 5 are examples; there are others. In case 4, video, acoustic, forensic, and probe analysis indicate no contact made between the TASER probe and the suspect's chest. The emergency medical technician paramedic present documented and testified under oath that both pulse and respirations were present for >8 minutes after electronic control device (ECD) deployment. 2 Dr Zipes, as an expert witness in this case, either missed or disregarded this information. For case 5, every medical personnel interpreted all of the rhythm strips (3 cardiac rhythm strips by emergency medical services personnel and 1 by an emergency medical physician) as asystole, whereas Dr Zipes chose fine ventricular fibrillation (personal communication with Michael Brave and Rich versus Taser Testimony, Taser International, May 28, 2012). ECD safety has been demonstrated in large, independent epidemiological studies, 3 and studies show ECDs reduce suspect injuries by approximately two thirds. 4 Approximately 3 million ECD applications have occurred worldwide (personal communication with S Tuttle, TASER International, May 28, 2012). We believe that the case series from Dr Zipes must be put into context. Even assuming arguendo that these deaths were ECD caused, which we do not agree with, these must be compared with the ≈80 000 lethal force uses avoided by 1 600 000 ECD applications. 5 In comparison, cardiac electrophysiologists warn patients that routine procedures have mortality risks of ≥1:10 000. ECD use is not risk free. Practice advances, in medicine or law enforcement, always have potential complication rates. Since January 2005, TASER's training materials have included the Pacing and Clinical Electrophysiology (PACE) study's conclusions that, "[t]he safety index for an [ECD] discharge was shown to have a significant and positive association to weight. Discharge levels for standard electric [ECDs] have an extremely low probability of inducing [ventricular fibrillation]." As Dr Zipes notes, in 2009 TASER recommended avoidance of ECD chest deployments if possible. The caveat "if possible" is crucial because officers do not always have the luxury to accurately aim during dynamic confrontations. TASER proactively made the conservative recommendation without definite data support because of public concerns that ECDs might have a cardiac effect, albeit miniscule. We are committed to continuous improvement and product safety.
Circulation, Oct 1, 1983
Iti an 18-year-old patient without manifest or concealed Wolff-Parkinson-White syndrome, spontane... more Iti an 18-year-old patient without manifest or concealed Wolff-Parkinson-White syndrome, spontaneous and paced left atrial impulses penetrated a left-sided AV nodal input and thereafter activated the ventricles in a normal fashion exclusively through the His-Purkinje system. On the other hand, sinus and paced right atrial impulses entered a right-sided atrioventricular nodal input that was completely dissociated from the left-sided input to subsequently activate the ventricles partly through Mahaim fibers and partly through the His-Purkinje system. The Mahaim fibers, which acted as "bystanders" during episodes of atrioventricular nodal reciprocating tachycardia, seemed to have extended from a "distal," common (right-sided) intranodal pathway (or "proximal" His bundle) to the right ventricle or, although this is less likely, to the right bundle branch. More studies are necessary to determine whether the association on the surface electrocardiogram of an ectopic slow left atrial rhythm with changes in QRS morphology (but not in QRS duration) always reflects the existence of Mahaim fibers.
PubMed, May 1, 1979
Our case of azygos continuation of the inferior vena cava is very rare because there was no assoc... more Our case of azygos continuation of the inferior vena cava is very rare because there was no associated heart disease or abdominal situs inversus. The diagnosis of this anomaly of the inferior vena cava should be suspected by observation of a dilated azygos vein on the chest roentgenogram and confirmed by venography.
Pacing and Clinical Electrophysiology, Feb 1, 1997
Pacing and Clinical Electrophysiology, 1999
of System Performance in ICD Patients Without Spontaneous Shocks. One hundred five implantable ca... more of System Performance in ICD Patients Without Spontaneous Shocks. One hundred five implantable cardioverter defibrillator (ICD) patients (71 ± 9 years of age, 83% men) without spontaneous ICD discharges for ^12 months were tested to assess high voltage (HV) circuit integrity and the system's ability to recognize and terminate ventricular fibrillation (VF). Indications for ICD implantation were sustained ventricular tachycardia (VT) (35%), cardiac arrest (27%), and inducible VT (38%). Eighty-two percent ofthe patients had coronary artery disease (CAD), and the mean left ventricular ejection fraction (LVEF) was 36% ± 13%. Results: One hundred patients had inducible VF and five did not. Testing led to ICD reprogramming in 50 (49%) patients. Two (1.9%) patients required ICD replacement: (1) a 45-year-old patient with a Ventritex 110 ICD implanted for 13 months interfaced with a CPI 0062 lead implanted for 46 months could not be defibrillated internally (impedance nonmeasurable); (2) an 82-yearold patient with a 23-month-old Medtronic 7219 ICD interfaced with 6936 and 6933 leads whose defibrillation threshold (DFT) had doubled since implantation (24 Jfrom 12 J). Lead fractures were found in both cases (proximal coil ofthe 0062, and subcutaneously in the 6933). Based on DFT determinations, the first shock output was programmed lower in 37 patients and higher in 10 patients. Shock pulse width was changed in one patient and the ventricular refractory period in another. No programming changes were made in 54 (51 %) patients. Conclusions: (1) Late testing ofHV circuit integrity in ICD patients without an ICD shock in s 12 months identifies previously unsuspected HV lead fractures; (2) chronic DFT testing resulted in HV output reprogramming in one-half of the patients.
American Journal of Cardiology, Aug 1, 1984
Annihilation and one-to-one entrainment of modulated parasystolic rhythms in humans has not been ... more Annihilation and one-to-one entrainment of modulated parasystolic rhythms in humans has not been previously discussed. In 9 nonmedicated patients, it was possible to measure the intrinsic, parasystolic ectopic cycle length given by the intervals between 2 consecutive parasystolic beats without any interposed nonparasystolic beat. The corresponding values varied between 960 and 2,350 ms (corresponding to rates between 62 and 26 beats/min). In addition, modulation could be determined, because nonparasystolic beats falling during the initial 59% of the cycle prolonged the parasystolic cycle length (by 12 to 37.5%), whereas those that fell later in the cycle shortened it (by 9 to 25%). Plotting this prolongation or shortening as a function of the temporal position of the nonparasystolic beats in the cycle yielded biphasic response curves, of which 7 were symmetric and 2 asymmetric. In 2 patients, episodes of concealed one-to-one entrainment were initiated by late nonparasystolic (sinus) beats and, later on, terminated by early ventricular extrasystoles. In 2 other patients (and in 2 separate occasions) nonparasystolic beats, falling in part of the cycle located in between those of maximal delay and acceleration, produced pacemaker annihilation (cessation of automatic activity for the remaining monitoring time). Parasystolic annihilation and concealed entrainment may be one of the causes that can explain the large, spontaneous, day-to-day variability in the incidence of ectopic ventricular beats reported in Holter recordings. Nevertheless, future prospective studies performing interventions that can change the sinus and ectopic rates are required to corroborate our finding.
Pacing and Clinical Electrophysiology, Dec 1, 1990