Rate Adaptive Pacing: Memories From a Bygone Era.

With the recognised physiologic value of dual chamber pacing, there was, at the commencement of the 1980s, an intense search for sensors to enable ventricular pacemakers to alter the pulse repetition rate in response to physiologic demand. Manufacturers fell into two main groups; those who chose highly physiologic sensors often requiring special pacing leads and those whose sensors allowed a standard pacing lead. Thirteen (13) sensors for rate adaptive pacing progressed at least to human investigational studies. Eventually the activity sensor, which responded quickly to exercise, but not to emotional stimuli or pyrexia and used a standard lead would predominate, with all manufacturers eventually accepting what was the least physiologic sensor investigated. The activity-based rate response was not dependent on cardiac or pulmonary disease, which could nullify the response with many of the other sensors. Three (3) other sensors survived that period and are still available today; minute ventilation, closed loop stimulation and central venous temperature, with the first two incorporated with activity as dual sensor systems. This review will outline the development of all the sensors used for rate adaptive pacing.

The Cardiac Pacemaker Clinic: Memories From a Bygone Era.

In 1963, soon after the first ventricular pacemakers were implanted at the Royal Melbourne Hospital, attempts were made to identify impending pacing failure, thus preventing sudden death in these very vulnerable patients. By 1970, patient numbers had increased, a formal regular pacemaker clinic was established, and guidelines and protocols developed. The clinic was staffed by a physician, a biomedical engineer and cardiac technicians. The unipolar, asynchronous, non-programmable pulse generators were powered by mercuric oxide/zinc batteries and implanted in the abdomen, using either transvenous or epimyocardial leads. Although, pulse generators were electively replaced at 3 years, most had already been replaced because of power source depletion, electronic failure or lead issues. Testing in all patients involved an electrocardiographic rhythm strip and electronic analysis of the stimulus artefact using a calibrated high-speed storage oscilloscope. Results were compared to previous studies and significant changes were interpreted as impending power source depletion. As a result of this testing, 97% of cases of impending power source depletion were detected prior to failure. These findings allowed testing each 4 months and for pulse generator life to be extended beyond three years. With ventricular triggered pulse generators, new testing procedures were designed. With time, visiting regional centres and clinical evaluation of new products became important functions of the clinic.

The Development of Pacemaker Programming: Memories From a Bygone Era.

Programmability is a stable, reversible change in the operating parameters of a cardiac implantable electronic device. The era of non-invasive programming began in 1972, with the development of a dedicated hand-held battery-operated device. Prior to this, there had been crude attempts, involving invasive procedures or a magnet, to change the pacemaker operating parameters. A non-invasive programming system requires an implanted pulse generator and an external programmer, communicating via an energy link. This was initially a pulsed magnetic field allowing opening and closing of a reed switch in the pulse generator in synchrony with the pulses. Soon after, radiofrequency communication was introduced and involved transmission of pulsing on-off radiofrequency bursts, which allowed complex encoding, that recognised the implanted hardware, prevented mis-programming, had security features and confirmed successful programming. As programming became more complex and sophisticated, programmers evolved into desktop models with programming wands and printers. By 1978, multiprogrammable programmers with bidirectional telemetry were introduced and became a driving force in the development of new cardiac implantable technologies and devices.

Prescription to reduce heart palpitations, a mid-18th century prescription in the New Kingdom of Granada.

The human being, throughout history, has used plants to prevent and cure diseases. It is important to know that for a long time, the mechanism through which those plants worked was unknown, making herbal medicine a purely empirical science. Medical prescriptions in the 19th century in the Kingdom of Nueva Granada were considered a significant medical advance as a result of knowledge and medical practices in the old continent. Medical literature of the time achieved, despite the lack of studies, the development of new schemes with exact dosages and new therapeutic possibilities. The medical prescription presented in this article was used in the management of heart palpitations, a frequent symptom nowadays, described as thoracic and/or neck beating, underlying various cardiac and non-cardiac diseases. The recipe for the palpitations of the historical archive "Cipriano Rodríguez Santa María" is a mixture of herbal agents that, as reviewed in the medical literature, showed to have anti-inflammatory, anxiolytic, and antioxidant effects, among others, allowing a beneficial effect on cardiac palpitations. Due to the lack of information on the posology, safety in its use, contraindications, and possible adverse effects, its potential use should have been underestimated at that time for the control of palpitations or as phytochemical agents directed to treat diseases causing this symptom.

A lo largo de la historia, el ser humano ha utilizado plantas para prevenir, aliviar y curar enfermedades. Cabe destacar que durante mucho tiempo se desconoció el mecanismo por el cual su uso era beneficioso, lo que hacía de la fitoterapia una ciencia netamente empírica. Las recetas médicas eran consideradas un avance médico significativo, resultado de conocimientos y prácticas traídas desde el viejo continente. Pese a la carencia de estudios locales, la literatura médica de la época permitió utilizar la biodiversidad de América para el desarrollo, investigación y uso de nuevos esquemas fitoterapéuticos con dosificaciones establecidas e indicaciones de uso, incluso un lugar específico de dispensación, ampliando aún más las posibilidades terapéuticas. La receta médica que se expone en este artículo era empleada en el manejo de las palpitaciones cardiacas, síntoma frecuente aún en la actualidad, descrito como golpes en tórax y/o cuello, subyacente en diversas enfermedades cardiacas y no cardiacas. La receta para las palpitaciones del archivo histórico Cipriano Rodríguez Santa María es una mezcla de agentes herbarios que, al realizar una revisión en la literatura médica, evidencian efectos antiinflamatorios, ansiolíticos y antioxidantes entre otros, sustentando un posible efecto beneficioso en las palpitaciones cardiacas. Debido a la ausencia de información sobre la posología, seguridad en su uso, contraindicaciones y posibles efectos adversos, es subestimado su potencial uso en aquel entonces para el control de las palpitaciones o como unos agentes fitoquímicos dirigidos para tratar enfermedades causantes de dicho síntoma.

Prescription to reduce heart palpitations, a mid-18th century prescription in the New Kingdom of Granada / Formulación para reducir las palpitaciones cardiacas, una receta médica de mediados del siglo xviii en el Nuevo Reino de Granada

Abstract The human being, throughout history, has used plants to prevent and cure diseases. It is important to know that for a long time, the mechanism through which those plants worked was unknown, making herbal medicine a purely empirical science. Medical prescriptions in the 19th century in the Kingdom of Nueva Granada were considered a significant medical advance as a result of knowledge and medical practices in the old continent. Medical literature of the time achieved, despite the lack of studies, the development of new schemes with exact dosages and new therapeutic possibilities. The medical prescription presented in this article was used in the management of heart palpitations, a frequent symptom nowadays, described as thoracic and/or neck beating, underlying various cardiac and non-cardiac diseases. The recipe for the palpitations of the historical archive "Cipriano Rodríguez Santa María" is a mixture of herbal agents that, as reviewed in the medical literature, showed to have anti-inflammatory, anxiolytic, and antioxidant effects, among others, allowing a beneficial effect on cardiac palpitations. Due to the lack of information on the posology, safety in its use, contraindications, and possible adverse effects, its potential use should have been underestimated at that time for the control of palpitations or as phytochemical agents directed to treat diseases causing this symptom.

Resumen A lo largo de la historia, el ser humano ha utilizado plantas para prevenir, aliviar y curar enfermedades. Cabe destacar que durante mucho tiempo se desconoció el mecanismo por el cual su uso era beneficioso, lo que hacía de la fitoterapia una ciencia netamente empírica. Las recetas médicas eran consideradas un avance médico significativo, resultado de conocimientos y prácticas traídas desde el viejo continente. Pese a la carencia de estudios locales, la literatura médica de la época permitió utilizar la biodiversidad de América para el desarrollo, investigación y uso de nuevos esquemas fitoterapéuticos con dosificaciones establecidas e indicaciones de uso, incluso un lugar específico de dispensación, ampliando aún más las posibilidades terapéuticas. La receta médica que se expone en este artículo era empleada en el manejo de las palpitaciones cardiacas, síntoma frecuente aún en la actualidad, descrito como golpes en tórax y/o cuello, subyacente en diversas enfermedades cardiacas y no cardiacas. La receta para las palpitaciones del archivo histórico Cipriano Rodríguez Santa María es una mezcla de agentes herbarios que, al realizar una revisión en la literatura médica, evidencian efectos antiinflamatorios, ansiolíticos y antioxidantes entre otros, sustentando un posible efecto beneficioso en las palpitaciones cardiacas. Debido a la ausencia de información sobre la posología, seguridad en su uso, contraindicaciones y posibles efectos adversos, es subestimado su potencial uso en aquel entonces para el control de las palpitaciones o como unos agentes fitoquímicos dirigidos para tratar enfermedades causantes de dicho síntoma.

Prescription to reduce heart palpitations, a mid-18th century prescription in the New Kingdom of Granada.

The human being, throughout history, has used plants to prevent and cure diseases. It is important to know that for a long time, the mechanism through which those plants worked was unknown, making herbal medicine a purely empirical science. Medical prescriptions in the 19th century in the Kingdom of Nueva Granada were considered a significant medical advance, as a result of knowledge and medical practices in the old continent. Medical literature of the time achieved, despite the lack of studies, the development of new schemes with exact dosages and new therapeutic possibilities. The medical prescription presented in this article was used in the management of heart palpitations, a frequent symptom nowadays, described as thoracic and/or neck beating, underlying various cardiac and non-cardiac diseases. The recipe for the palpitations of the historical archive "Cipriano Rodríguez Santa María" is a mixture of herbal agents that, as reviewed in the medical literature, showed to have anti-inflammatory, anxiolytic, and antioxidant effects, among others, allowing a beneficial effect on cardiac palpitations. Due to the lack of information on the posology, safety in its use, contraindications and possible adverse effects, its potential use should have been underestimated at that time for the control of palpitations or as phytochemical agents directed to treat diseases causing this symptom.

A lo largo de la historia, el ser humano ha utilizado plantas para prevenir, aliviar y curar enfermedades. Cabe destacar que durante mucho tiempo se desconoció el mecanismo por el cual su uso era beneficioso, lo que hacía de la fitoterapia una ciencia netamente empírica. Las recetas médicas eran consideradas un avance médico significativo, resultado de conocimientos y prácticas traídas desde el viejo continente. Pese a la carencia de estudios locales, la literatura médica de la época permitió utilizar la biodiversidad de América para el desarrollo, investigación y uso de nuevos esquemas fitoterapéuticos con dosificaciones establecidas e indicaciones de uso, incluso un lugar específico de dispensación, ampliando aún más las posibilidades terapéuticas. La receta médica que se expone en este artículo era empleada en el manejo de las palpitaciones cardiacas, síntoma frecuente aún en la actualidad, descrito como golpes en tórax y/o cuello, subyacente en diversas enfermedades cardiacas y no cardiacas. La receta para las palpitaciones del archivo histórico Cipriano Rodríguez Santa María es una mezcla de agentes herbarios que, al realizar una revisión en la literatura médica, evidencian efectos antiinflamatorios, ansiolíticos y antioxidantes entre otros, sustentando un posible efecto beneficioso en las palpitaciones cardiacas. Debido a la ausencia de información sobre la posología, seguridad en su uso, contraindicaciones y posibles efectos adversos, es subestimado su potencial uso en aquel entonces para el control de las palpitaciones o como unos agentes fitoquímicos dirigidos para tratar enfermedades causantes de dicho síntoma.

Arritmología pediátrica, el reto del siglo XXI / Paediatric arrhythmology: The challenge of the 21st century

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