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Escudero CA, Ceresnak SR, Collins KK, Pass RH, Aziz PF, Blaufox AD, Ortega MC, Cannon BC, Cohen MI, Dechert BE, Dubin AM, Motonaga KS, Epstein MR, Erickson CC, Fishberger SB, Gates GJ, Capone CA, Nappo L, Kertesz NJ, Kim JJ, Valdes SO, Kubuš P, Law IH, Maldonado J, Moore JP, Perry JC, Sanatani S, Seslar SP, Shetty I, Zimmerman FJ, Skinner JR, Marcondes L, Stephenson EA, Asakai H, Tanel RE, Uzun O, Etheridge SP, Janson CM. Loss of ventricular preexcitation during noninvasive testing does not exclude high-risk accessory pathways: A multicenter study of WPW in children. Heart Rhythm 2020; 17:1729-1737. [DOI: 10.1016/j.hrthm.2020.05.035] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 05/25/2020] [Accepted: 05/27/2020] [Indexed: 11/25/2022]
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Hena Z, Sutton NJ, Gates GJ, Taragin BH, Pass RH. Initial experience with the 3.3 Fr Mongoose ® pigtail catheter for aortic angiography during patent ductus arteriosus closure in small patients. Ann Pediatr Cardiol 2017; 10:240-244. [PMID: 28928609 PMCID: PMC5594934 DOI: 10.4103/apc.apc_9_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Smaller femoral arterial sheaths may be associated with fewer vascular complications. The 3.3 Fr Mongoose® Pediavascular pigtail catheter is a catheter that allows higher flow rates, potentially resulting in improved angiographic quality. We reviewed our experience with this small catheter during patent ductus arteriosus (PDA) closure. MATERIALS AND METHODS Review of patients ≤20 kg in whom the Mongoose® catheter was used during PDA closure from 12/13 to 4/15. Angiographic efficacy and procedural details were compared to ten 4 Fr catheter cases. Comparisons were performed using Mann-Whitney U-test; P < 0.05 was statistically significant. RESULTS Twelve (9 female) patients were catheterized with a 3.3 Fr Mongoose®. Median weight 10.5 kg (range 6.4-18.2), height 81 cm (range 37-111), and body surface area (BSA) 0.47 m2 (range 0.33-0.75) were similar to ten patients (3 females) in the 4 Fr control group (P = NS); median weight 9.9 kg (range 6-16.8), height 80 cm (range 64-102), and BSA 0.46 m2 (range 0.31-0.74). Angiographic quality was subjectively adequate with both with no difference in the median pixel density between the two techniques (3.3 Fr: 76.7 [range 33.5-90] and 4 Fr: [70; 38-102]; P = NS). Contrast used was similar between the groups (3.3 Fr: median 4.2 ml/kg and 4 Fr: 4.9 ml/kg; P = NS). Median radiation dose was similar in the two groups (3.3 Fr: 28.1 mGy [range 17.2-38] and 4 Fr: 38 mGy [range 20.4-58.5]; P = NS). All ducts were closed at latest follow-up (P = NS). No complications were encountered. CONCLUSIONS The 3.3 Fr Mongoose® allowed similar angiography to the 4 Fr pigtail catheter, allowing safe and effective transcatheter PDA closure in small children.
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Affiliation(s)
- Zachary Hena
- Department of Pediatrics, Division of Pediatric Cardiology, The Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Nicole J Sutton
- Department of Pediatrics, Division of Pediatric Cardiology, The Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Gregory J Gates
- Department of Pediatrics, Division of Pediatric Cardiology, The Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Benjamin H Taragin
- Department of Radiology, Division of Pediatric Cardiology, The Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Robert H Pass
- Department of Pediatrics, Division of Pediatric Cardiology, The Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, NY, USA
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Capone CA, Ceresnak SR, Nappo L, Gates GJ, Schechter CB, Pass RH. Three-Catheter Technique for Ablation of Left-Sided Accessory Pathways in Wolff-Parkinson-White is Less Expensive and Equally Successful When Compared to a Five-Catheter Technique. Pacing Clin Electrophysiol 2015; 38:1405-11. [PMID: 26400468 DOI: 10.1111/pace.12742] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Accepted: 08/18/2015] [Indexed: 11/28/2022]
Abstract
PURPOSE To compare the efficacy, safety, and cost-effectiveness of a three-catheter approach with a conventional five-catheter approach for the mapping and ablation of supraventricular tachycardia in pediatric patients with Wolff-Parkinson-White Syndrome (WPW) and concealed accessory pathways (APs). METHODS A retrospective review from 2008 to 2012 of patients less than 21 years with WPW who underwent a three-catheter radiofrequency (RF) ablation of a left-sided AP (ablation, right ventricular [RV] apical, and coronary sinus [CS] decapolar catheters) was performed. The three-catheter group was compared to a control group who underwent a standard five-catheter (ablation, RV apical, CS decapolar, His catheter, and right atrial catheter) ablation for the treatment of left-sided WPW or concealed AP. Demographics, ablation outcomes, and costs were compared between groups. RESULTS Twenty-eight patients met inclusion criteria with 28 control patients. The groups did not differ in gender, age, weight, or body surface area. Locations of the AP on the mitral annulus were similar between the groups. All patients were ablated via transseptal approach. Note that 28 of 28 in the three-catheter group (100%) and 27 of 28 (96%) controls were acutely successfully ablated (P = 0.31). No complications were encountered. There was no difference in procedural time, time to loss of AP conduction, or number of RF applications. Use of the three-catheter technique resulted in a total savings of $2,465/case, which includes the $680 savings from using fewer catheters as well as the savings from a shortened procedure time. CONCLUSIONS Ablation in patients with WPW and a left-sided AP can be performed using three catheters with similar efficacy and safety while offering significant cost savings compared to a conventional five-catheter approach.
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Affiliation(s)
- Christine A Capone
- Pediatric Arrhythmia Service, Division of Pediatric Cardiology, Department of Pediatrics, The Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, New York
| | - Scott R Ceresnak
- Pediatric Cardiology, Pediatric Electrophysiology, Department of Pediatrics, Lucille Packard Children's Hospital, Stanford University, Palo Alto, California
| | - Lynn Nappo
- Pediatric Arrhythmia Service, Division of Pediatric Cardiology, Department of Pediatrics, The Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, New York
| | - Gregory J Gates
- Pediatric Arrhythmia Service, Division of Pediatric Cardiology, Department of Pediatrics, The Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, New York
| | - Clyde B Schechter
- Department of Family and Social Medicine and Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York
| | - Robert H Pass
- Pediatric Arrhythmia Service, Division of Pediatric Cardiology, Department of Pediatrics, The Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, New York
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Osei FA, Gates GJ, Choi SJ, Hsu DT, Pass RH, Ceresnak SR. Abstract 125: Improving ECG Services at a Children’s Hospital: Implementation of a Digital ECG System. Circ Cardiovasc Qual Outcomes 2015. [DOI: 10.1161/circoutcomes.8.suppl_2.125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
Pediatric ECGs and ECG interpretation were all paper-based until 2012 at our Children’s Hospital. There were significant delay between the time when the ECGs were performed and when they were officially interpreted by a cardiologist for the formal the medical records. To better understand the factors contributing to the delay or failure to complete an ECG report, we created a Fishbone (Ishikawa) Diagram to help facilitate a solution. (See Diagram 1 below). We hypothesized that the introduction of a completely digital ECG system would increase the volume of ECGs interpreted and improve the capture and billing of ECG services.
Diagram 1-Fishbone diagram of factors affecting ECG flow
Methods:
As part of a hospital wide quality improvement initiative, a digital ECG service (Muse®, GE) was implemented at the Children’s Hospital at Montefiore in June 2012. The total volume of ECGs performed in the first 6 months of the digital ECG era (Post-Digital, June 2012 - Dec 2012) was compared to 18 months of the pre-digital era (Pre-Digital, Jan 2011 - May 2012). In addition, billing times were compared in the Pre-Digital and Post-Digital eras and an assessment of workflow were performed. Pre-Digital and Post-Digital data were compared via t-tests. (Diagram 2 illustrates the ECG workflow in both eras)
Diagram 2-ECG workflow in the Pre Digital vrs Digital Eras
Results:
Table 1
Conclusion:
Implementation of a digital ECG system increased the volume of ECGs interpreted and reported at a children’s Hospital.
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Affiliation(s)
| | - Gregory J Gates
- The Children’s Hosp at Montefiore – Albert Einstein College of Medicine, Bronx, NY
| | - Steven J Choi
- The Children’s Hosp at Montefiore – Albert Einstein College of Medicine, Bronx, NY
| | - Daphne T Hsu
- The Children’s Hosp at Montefiore – Albert Einstein College of Medicine, Bronx, NY
| | - Robert H Pass
- The Children’s Hosp at Montefiore – Albert Einstein College of Medicine, Bronx, NY
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Ceresnak SR, Liberman L, Silver ES, Fishberger SB, Gates GJ, Nappo L, Mahgerefteh J, Pass RH. Lone atrial fibrillation in the young - perhaps not so "lone"? J Pediatr 2013; 162:827-31. [PMID: 23092527 DOI: 10.1016/j.jpeds.2012.09.016] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2012] [Revised: 07/18/2012] [Accepted: 09/07/2012] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To determine if pediatric patients with a history of lone atrial fibrillation (AF) have other forms of supraventricular tachycardia (SVT) that may potentially trigger AF. STUDY DESIGN A multicenter review of patients with lone AF who underwent electrophysiology (EP) study from 2006-2011 was performed. INCLUSION CRITERIA age ≤21 years, normal ventricular function, structurally normal heart, history of AF, and EP study and/or ablation performed. EXCLUSION CRITERIA congenital heart disease or cardiomyopathy. Patient demographics, findings at EP study and follow-up data were recorded. RESULTS Eighteen patients met inclusion criteria. The mean age was 17.9 ± 2.2 years, weight was 82 ± 21 kg, body mass index was 27 ± 6, and 15 (83%) were males. Eleven (61%) were overweight or obese. Seven (39%) had inducible SVT during EP study: 5 atrioventricular nodal re-entry tachycardia (71%) and 2 concealed accessory pathways with inducible atrioventricular re-entry tachycardia (29%). All 7 patients with inducible SVT underwent radiofrequency ablation. There were no complications during EP study and/or ablation for all 18 patients. The mean follow-up was 1.7 ± 1.5 years and there were no recurrences in the 7 patients who underwent ablation. There were 2 recurrences of AF in patients with no other form of SVT during EP study. CONCLUSIONS Inducible SVT was found in 39% of pediatric patients undergoing EP study for lone AF. EP study should be considered for pediatric patients presenting with lone AF.
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Affiliation(s)
- Scott R Ceresnak
- Pediatric Arrhythmia Service, Division of Pediatric Cardiology, The Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, NY 10467-2490, USA.
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Gellis LA, Ceresnak SR, Gates GJ, Nappo L, Pass RH. Reducing patient radiation dosage during pediatric SVT ablations using an "ALARA" radiation reduction protocol in the modern fluoroscopic era. Pacing Clin Electrophysiol 2013; 36:688-94. [PMID: 23510152 DOI: 10.1111/pace.12124] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2012] [Revised: 01/17/2013] [Accepted: 01/27/2013] [Indexed: 11/29/2022]
Abstract
BACKGROUND Ablation for supraventricular tachycardia (SVT) relies upon fluoroscopy (fluoro), which exposes the patient and staff to ionizing radiation. The objective of this work was to present a new "ALARA--As Low As Reasonably Achievable" protocol with alterations to fluoroscopic x-ray parameters to reduce dose without an electroanatomical (EAM) approach. METHODS All patients <21 years of age undergoing ablation of SVT at our institution from June 2011 to April 2012 were included. EAM was not utilized in any case. An ALARA protocol of low frame rates (2 or 3 fps), low fluoro dose/frame (10-18 nGy/frame), and other techniques aimed at reducing use of fluoroscopy were employed. Demographics, procedural, and radiation data were analyzed. RESULTS Forty-two patients underwent ablation and were studied. Median age was 14.1 years (range 4.8-21.1 years), weight was 51 kg (range 18.2-75 kg), and body surface area was 1.51 m(2) (range 0.72- 1.94 m(2)). Seventeen (41%) had Wolff-Parkinson-White syndrome, 14 (33%) atrioventricular nodal reentrant tachycardia, and 11 (26%) concealed pathways. Median procedural time was 114 minutes (57-246 minutes). Median dose area product (DAP) for posterioanterior and lateral fluoroscopy was 343.2 uGym(2) (range 38.2-3,172 uGym(2)); the median air Kerma product (K) was 45.4 mGy (range 6.7-567.5 mGy). DAP and K are lower than prior data from EAM and fluoroscopy techniques. The acute success rate was 95%; no procedural complications. CONCLUSIONS An ALARA protocol for ablation of SVT reduced radiation to below levels previously reported for combined EAM/fluoro approaches. Success rates were excellent with no complications and without the costs of EAM.
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Affiliation(s)
- Laura A Gellis
- Pediatric Electrophysiology Service, Division of Pediatric Cardiology, Department of Pediatrics, The Children's Hospital at Montefior, Albert Einstein College of Medicin, Bronx, New York 10467, USA
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Ghosh R, Gates GJ, Schiller M, Walsh C, Pass R, Nappo L, Ceresnak S. THE PREVALENCE OF ARRHYTHMIAS DURING EXERCISE TESTING IN CHILDREN. J Am Coll Cardiol 2013. [DOI: 10.1016/s0735-1097(13)60518-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Capone CA, Ceresnak SR, Nappo L, Gates GJ, Pass RH. A COST-EFFECTIVE APPROACH TO RADIOFREQUENCY CATHETER ABLATION OF LEFT-SIDED ACCESSORY PATHWAYS IN YOUNG PATIENTS WITH WOLFF-PARKINSON-WHITE SYNDROME: A NOVEL THREE CATHETER TECHNIQUE. J Am Coll Cardiol 2013. [DOI: 10.1016/s0735-1097(13)60520-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Carpenter RJ, Dillard J, Zion AS, Gates GJ, Bartels MN, Downey JA, De Meersman RE. The Acute Effects of Acupuncture Upon Autonomic Balance in Healthy Subjects. Am J Chin Med 2012; 38:839-47. [DOI: 10.1142/s0192415x10008287] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Restoration of the sympathovagal (S/V) balance, involving a lowering of sympathetic and/or an augmentation of vagal modulation or a combination of both is associated with improvements in cardiovascular morbidity and mortality. To determine whether acupuncture exerts a favorable influence upon resting blood pressure and sympathovagal balance, a single-blind cross-over investigation was used to study the acute effects of acupuncture on S/V balance in normal healthy subjects. The ANOVA revealed a significant lowering of the sympathovagal balance (LF:HF) during rest for the acupuncture treatment from pre (4 ± 2 nu) to post (2.2 ± 1.8 nu)(p < 0.05). No such change was seen during sham treatment. The ANOVA revealed significant differences in systolic blood pressures during rest (114 ± 4 vs. 108 ± 3 mmHg) for the acupuncture treatment (p < 0.05). No significance was found during the sham treatment. The ANOVA failed to reveal any significant improvements in sympathovagal balance during the sustained isometric contraction. The clinical significance of these findings appears to suggest that acupuncture treatment might be beneficial in lowering blood pressure at rest. Furthermore, the lowering of the blood pressure might be in part due to a lowering of the sympathovagal balance. These findings are of importance since acupuncture treatments are non-pharmacological and have no known detrimental side-effects. This investigation employed healthy volunteers, yet acupuncture has been found to have more potent effects in animal models of hypertension and or in the presence of an autonomic imbalance.
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Affiliation(s)
- Rosann J. Carpenter
- Department of Rehabilitation Medicine, College of Physicians and Surgeons of Columbia University and Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY 10027, USA
| | - James Dillard
- Department of Rehabilitation Medicine, College of Physicians and Surgeons of Columbia University and Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY 10027, USA
| | - Adrienne S. Zion
- Department of Rehabilitation Medicine, College of Physicians and Surgeons of Columbia University and Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY 10027, USA
| | - Gregory J. Gates
- Department of Rehabilitation Medicine, College of Physicians and Surgeons of Columbia University and Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY 10027, USA
| | - Matthew N. Bartels
- Department of Rehabilitation Medicine, College of Physicians and Surgeons of Columbia University and Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY 10027, USA
| | - John A. Downey
- Department of Rehabilitation Medicine, College of Physicians and Surgeons of Columbia University and Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY 10027, USA
| | - Ronald E. De Meersman
- Department of Rehabilitation Medicine, College of Physicians and Surgeons of Columbia University and Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY 10027, USA
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Ceresnak SR, Gates GJ, Nappo L, Cohen HW, Pass RH. Novel method of signal analysis for ablation of Wolff-Parkinson-White syndrome. Heart Rhythm 2012; 9:2-7. [PMID: 21872561 DOI: 10.1016/j.hrthm.2011.08.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2011] [Accepted: 08/22/2011] [Indexed: 11/13/2022]
Affiliation(s)
- Scott R Ceresnak
- The Pediatric Arrhythmia Service, Division of Pediatric Cardiology, Department of Pediatrics, The Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, New York 10467-2490, USA.
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Gates GJ, Bartels MN, Downey JA, De Meersman RE. The effect of chemoreceptor stimulation upon muscle sympathetic nerve activity. Respir Physiol Neurobiol 2009; 167:268-72. [DOI: 10.1016/j.resp.2009.05.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2009] [Revised: 05/14/2009] [Accepted: 05/20/2009] [Indexed: 11/28/2022]
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Wadhwa H, Gradinaru C, Gates GJ, Badr MS, Mateika JH. Impact of intermittent hypoxia on long-term facilitation of minute ventilation and heart rate variability in men and women: do sex differences exist? J Appl Physiol (1985) 2008; 104:1625-33. [PMID: 18403450 DOI: 10.1152/japplphysiol.01273.2007] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Following exposure to intermittent hypoxia, respiratory motor activity and sympathetic nervous system activity may persist above baseline levels for over an hour. The present investigation was designed to determine whether sustained increases in minute ventilation and sympathovagal (S/V) balance, in addition to sustained depression of parasympathetic nervous system activity (PNSA), were greater in men compared with women following exposure to intermittent hypoxia. Fifteen healthy men and women matched for age, race, and body mass index were exposed to eight 4-min episodes of hypoxia during sustained hypercapnia followed by a 15-min end-recovery period. The magnitude of the increase in minute ventilation during the end-recovery period, compared with baseline, was similar in men and women (men, 1.52 +/- 0.03; women, 1.57 +/- 0.02 fraction of baseline; P < 0.0001). In contrast, depression of PNSA and increases in S/V balance were evident during the end-recovery period, compared with baseline, in men (PNSA, 0.66 +/- 0.06 fraction of baseline, P < 0.0001; S/V balance, 2.8 +/- 0.7 fraction of baseline, P < 0.03) but not in women (PNSA, 1.27 +/- 0.19 fraction of baseline, P = 0.3; S/V balance, 1.8 +/- 0.6 fraction of baseline, P = 0.2). We conclude that a sustained increase in minute ventilation, which is indicative of long-term facilitation, is evident in both men and women following exposure to intermittent hypoxia and that this response is independent of sex. In contrast, sustained alterations in autonomic nervous system activity were evident in men but not in women.
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Affiliation(s)
- Harpreet Wadhwa
- Department of Physiology, Wayne State University School of Medicine, Detroit, Michigan, USA
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Abstract
Acute resistance exercise (RE) has been shown to reduce cardiac vagal control. Whether this would in turn affect QTc interval (an index of ventricular depolarization/repolarization) or heart rate complexity is not known. Heart rate variability (HRV), heart rate complexity (SampEn), and QT interval (rate corrected using Bazett, Fridericia, Hodges, and Framingham) were measured before and 5 min after an acute RE bout in twelve healthy young men. Normalized high frequency power of HRV (an index of cardiac parasympathetic modulation; HF (nu)), and SampEn were reduced following RE (p < 0.05). Bazett corrected QTc interval increased following RE (p < 0.05). Change in HF (nu) from rest to recovery was correlated with both change in SampEn (r = 0.51, p < 0.05) and change in QTc interval for each method of correction (r = - 0.67 to - 0.70, p < 0.05). Acute RE reduced HF spectral power of HRV and this was related to both reduced heart rate complexity and increased QTc length. Thus, during recovery from acute RE, there is prolongation of depolarization and repolarization of the ventricles concomitant with reduced cardiac irregularity, and this may be related to a reduction in cardiac vagal control.
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Affiliation(s)
- K S Heffernan
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Champaign, IL 61820, USA.
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Gates GJ, Mateika SE, Mateika JH. Heart rate variability in non-apneic snorers and controls before and after continuous positive airway pressure. BMC Pulm Med 2005; 5:9. [PMID: 16048652 PMCID: PMC1208915 DOI: 10.1186/1471-2466-5-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2005] [Accepted: 07/27/2005] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND We hypothesized that sympathetic nervous system activity (SNSA) is increased and parasympathetic nervous system activity (PNSA) is decreased during non-rapid eye movement (NREM) sleep in non-apneic, otherwise healthy, snoring individuals compared to control. Moreover, we hypothesized that these alterations in snoring individuals would be more evident during non-snoring than snoring when compared to control. METHODS To test these hypotheses, heart rate variability was used to measure PNSA and SNSA in 11 normotensive non-apneic snorers and 12 control subjects before and 7-days after adapting to nasal continuous positive airway pressure (nCPAP). RESULTS Our results showed that SNSA was increased and PNSA was decreased in non-apneic snorers during NREM compared to control. However, these changes were only evident during the study in which snoring was eliminated with nCPAP. Conversely, during periods of snoring SNSA and PNSA were similar to measures obtained from the control group. Additionally, within the control group, SNSA and PNSA did not vary before and after nCPAP application. CONCLUSION Our findings suggest that long-lasting alterations in autonomic function may exist in snoring subjects that are otherwise healthy. Moreover, we speculate that because of competing inputs (i.e. inhibitory versus excitatory inputs) to the autonomic nervous system during snoring, the full impact of snoring on autonomic function is most evident during non-snoring periods.
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Affiliation(s)
- Gregory J Gates
- Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY, USA
| | - Susan E Mateika
- Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY, USA
| | - Jason H Mateika
- Departments of Internal Medicine and Physiology, Wayne State University School of Medicine, Detroit, MI, USA
- Research and Development, John D. Dingell Veterans Administration Medical Center, Detroit, MI, USA
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Zhong X, Hilton HJ, Gates GJ, Jelic S, Stern Y, Bartels MN, Demeersman RE, Basner RC. Increased sympathetic and decreased parasympathetic cardiovascular modulation in normal humans with acute sleep deprivation. J Appl Physiol (1985) 2005; 98:2024-32. [PMID: 15718408 DOI: 10.1152/japplphysiol.00620.2004] [Citation(s) in RCA: 286] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Cardiovascular autonomic modulation during 36 h of total sleep deprivation (SD) was assessed in 18 normal subjects (16 men, 2 women, 26.0 +/- 4.6 yr old). ECG and continuous blood pressure (BP) from radial artery tonometry were obtained at 2100 on the first study night (baseline) and every subsequent 12 h of SD. Each measurement period included resting supine, seated, and seated performing computerized tasks and measured vigilance and executive function. Subjects were not supine in the periods between measurements. Spectral analysis of heart rate variability (HRV) and BP variability (BPV) was computed for cardiac parasympathetic modulation [high-frequency power (HF)], sympathetic modulation [low-frequency power (LF)], sympathovagal balance (LF/HF power of R-R variability), and BPV sympathetic modulation (at LF). All spectral data were expressed in normalized units [(total power of the components/total power-very LF) x 100]. Spontaneous baroreflex sensitivity (BRS), based on systolic BP and pulse interval powers, was also measured. Supine and sitting, BPV LF was significantly increased from baseline at 12, 24, and 36 h of SD. Sitting, HRV LF was increased at 12 and 24 h of SD, HRV HF was decreased at 12 h SD, and HRV LF/HF power of R-R variability was increased at 12 h of SD. BRS was decreased at 24 h of SD supine and seated. During the simple reaction time task (vigilance testing), the significantly increased sympathetic and decreased parasympathetic cardiac modulation and BRS extended through 36 h of SD. In summary, acute SD was associated with increased sympathetic and decreased parasympathetic cardiovascular modulation and decreased BRS, most consistently in the seated position and during simple reaction-time testing.
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Affiliation(s)
- Xu Zhong
- Division of Pulmonary, Allergy and Critical Care, Columbia University College of Physicians & Surgeons, 622 West 168th Street, VC 12-206, New York, NY 10032, USA
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Gates GJ, Mateika SE, Basner RC, Mateika JH. Baroreflex sensitivity in nonapneic snorers and control subjects before and after nasal continuous positive airway pressure. Chest 2004; 126:801-7. [PMID: 15364759 DOI: 10.1378/chest.126.3.801] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
HYPOTHESIS We hypothesized that baroreflex sensitivity is decreased during wakefulness and non-rapid eye movement sleep in normotensive, nonapneic snorers who are otherwise healthy. Moreover, we hypothesized that nocturnal alterations in baroreflex sensitivity are abolished during the application of nasal continuous positive airway pressure (nCPAP). DESIGN The sequencing technique was used to measure baroreflex sensitivity in 16 normotensive nonapneic snorers and 16 control subjects matched for age, height, weight, gender, and race. Subsequently, baroreflex sensitivity was measured in 12 of 16 snorers and 14 of 16 control subjects during the application of nCPAP. RESULTS Mean (+/- SE) baroreflex sensitivity was reduced during sleep in the nonapneic snoring group (wakefulness, 20.99 +/- 1.46 ms/mm Hg; sleep, 15.85 +/- 1.49 ms/mm Hg), but not in the control group (wakefulness, 21.82 +/- 2.48 ms/mm Hg; sleep, 23.54 +/- 2.18 ms/mm Hg). This reduction was abolished by the application of nCPAP in the snoring group (before nCPAP therapy, 16.30 +/- 2.17 ms/mm Hg; during nCPAP therapy, 20.63 +/- 2.40 ms/mm Hg). The application of nCPAP did not alter baroreflex sensitivity in the control group (before nCPAP therapy, 23.54 +/- 2.18 ms/mm Hg; during nCPAP therapy, 22.56 +/- 1.73 ms/mm Hg). BP was not significantly different between the snoring and control groups either before or during nCPAP application. CONCLUSIONS Our findings suggest that nocturnal alterations in baroreflex sensitivity may exist in nonapneic snoring subjects prior to alterations in other cardiovascular variables.
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Affiliation(s)
- Gregory J Gates
- John D. Dingell VA Medical Center, 4646 John R (11R), Room 4308, Detroit, MI 48201, USA
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Gates GJ, Sonenstein FL. Heterosexual genital sexual activity among adolescent males: 1988 and 1995. Fam Plann Perspect 2000; 32:295-7, 304. [PMID: 11138866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 04/15/2023]
Abstract
CONTEXT Researchers have paid little attention to adolescents' experience with genital sexual activity other than vaginal intercourse, even though oral and anal intercourse expose youth to the risk of sexually transmitted diseases. METHODS Males aged 15-19 interviewed in 1988 and 1995 as part of the National Survey of Adolescent Males were asked questions about whether they had ever engaged in a series of genital sexual activities. These data were collected in a self-administered questionnaire that respondents completed at the end of the interview. RESULTS In 1995, 55% of males aged 15-19 reported that they had ever engaged in vaginal intercourse, 53% that they had ever been masturbated by a female, 49% that they had ever received oral sex, 39% that they had ever given oral sex and 11% that they had ever engaged in anal sex. More than three-quarters of males who had had vaginal intercourse reported experience with masturbation or oral sex by a female. Moreover, one in five males who had never had vaginal intercourse reported having been masturbated by a female, and one in seven said they had received oral sex. Between 1988 and 1995, the proportion of males who reported having ever been masturbated by a female increased significantly, from 40% to 53%. There were less sizable shifts in the proportions who had received oral sex: Overall proportions were similar in both years, although levels more than doubled among black teenagers, an increase that brings them in line with levels of oral sex reported by white and Hispanic adolescent males in 1995. CONCLUSIONS Evidence from the National Survey of Adolescent Males showing that a substantial share of male teenagers engage in genital sexual activity beyond vaginal sexual intercourse underlines the importance of monitoring a broad spectrum of sexual behaviors among teenagers. More detailed data with larger samples of both males and females are needed to determine the frequency and timing of these behaviors. Measuring risk for STD infections among teenagers requires attention to all forms of genital sexual activity.
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Affiliation(s)
- G J Gates
- Population Studies Center, The Urban Institute, Washington, DC, USA
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Gates GJ, Alberter-Soussan R. Under one umbrella. A continuum of HIV service delivery. Caring 1993; 12:14-6, 18-9. [PMID: 10125242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Affiliation(s)
- G J Gates
- Home Nursing Agency AIDS Intervention Project, Altoona, PA
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