A test method for the evaluation of protective glove materials used in agricultural pesticide operations

The ASTM Standard Test Method for Resistance of Protective Clothing Materials to Permeation by Liquids and Gases (F 739-85) and the recommended permeation cell have been modified to permit the testing of protective clothing materials for permeation by the low volatility, low water solubility active ingredients present in many pesticide formulations. The modification makes use of solid collection medium, a thin (0.02-in. thick) sheet of silicone rubber, to collect permeants. Those compounds permeating the protective material can then be desorbed into an appropriate solvent and analyzed using conventional methods and instruments. A series of permeation tests have been conducted using samples of 10 common, commercially available protective glove materials and the modified cell. Permeation of the active ingredient as well as carrier solvent components of several concentrated pesticide formulations containing low volatility, low water solubility active ingredients and aromatic hydrocarbon carrier solvents has been monitored. The relative breakthrough and the total mass of material permeating the glove materials appears to be strongly related to the concentration of the aromatic carrier solvent present in the formulations studied to date. The collection method was found to be less useful for monitoring the permeation of active ingredients, which have reasonably high water solubilities. The results obtained by using this method with samples of protective glove materials challenged by several concentrated pesticide formulations are described. For these formulations containing xylene boiling range aromatic solvents, gloves made of nitrile rubber, butyl rubber, and Silver Shield were most resistant to permeation; natural rubber and polyethylene glove materials were least resistant.

Cumulative effects of amiodarone on inducibility of ventricular tachycardia: implications for electrophysiological testing

To determine whether the slow onset of action of amiodarone might result in a delayed effect on the inducibility of sustained ventricular arrhythmias, 45 patients with ischemic heart disease and inducible sustained monomorphic ventricular tachycardia were prospectively studied. Each patient had at least one initial repeat study on amiodarone and those with persistently inducible arrhythmias were rescheduled for further studies over the following 24 weeks. After 2-3 weeks of amiodarone therapy, nine patients no longer had inducible tachycardias, and tachycardia in another eight patients (18%) later became noninducible. Using life-table methods, analysis based on the results of the first re-study showed 18-month recurrence rates of 43% in the inducible vs 17% in the noninducible groups (p = 0.056). When the results of additional testing were then used to reclassify patients, the recurrence rates for these two groups were 50% and 17%, respectively (p = 0.004). Observation of blood pressure and level of consciousness during induced arrhythmias was also predictive of clinical tolerance in patients having recurrences; 16 of 19 patients experienced symptoms of similar severity to those produced during testing. We conclude: (1) early testing of amiodarone may result in misclassification of some patients as remaining inducible; (2) re-testing at a later time more accurately predicts tachycardia recurrence; (3) observation of hemodynamic response also provides important prognostic information.

Morphologic differences of the endocardial electrogram in beats of sinus and ventricular origin

The lack of accurate arrhythmia detection and identification is one of the major obstacles to improvement in the efficacy of antitachycardia devices. We evaluated a method for detection of beats of ventricular origin compared to sinus rhythm based on the morphology of the endocardial electrogram. In order to compare mechanically induced ventricular beats to normal sinus beats, endocardial electrograms from a standard pacing electrode were recorded from eight open-chested dogs. Time and frequency domain features analyzed included peak-to-peak amplitude (AMP), maximal slew rate (dV/dT), and frequency content (-3 dB downpoint). Quantitative morphologic comparison of the waveforms was performed using standard correlation and by the absolute area of difference between the waveform and a sinus beat template. The AMP and dV/dT for a group of ventricular beats did not differ significantly from beats of sinus origin. In the unipolar configuration -3 dB for ventricular beats was significantly different from sinus beats (p = .01), but overlap occurred in three of eight cases. Conversely, using either method of assessment of morphological differences, all ventricular beats could be identified without overlapping the values for normal beats. We concluded that morphologic analysis of the endocardial electrogram by such methods may be a highly accurate means of distinguishing between beats of sinus and ventricular origins. This technique may also be applicable to the problem of automatic rhythm identification by implanted devices.

The United States Environmental Protection Agency's guidelines for applicator exposure monitoring

The Environmental Protection Agency (EPA)'s proposed guidelines for studies which estimate worker exposure to pesticides during application and related work activities are discussed. These guidelines are intended to aid pesticide registrants in conducting occupational exposure monitoring studies for pesticide applicators at indoor and outdoor sites. The Agency's rationale for requiring exposure to be monitored with passive dosimetry techniques or by biological monitoring is described. The practical and theoretical advantages and disadvantages of both approaches are also discussed.

Pacemaker follow-up: its role in the detection and correction of pacemaker system malfunction

The goal of pacemaker follow-up is not only to detect battery depletion but also to detect all malfunctions of the pacing system and, when possible, to correct such problems using programming. During one year, we discovered 61 such malfunctions in a clinic of 1065 patients (5.7%). These were more frequent in the first year (7.7%) than in the third to fifth years of follow-up (range 3.1-4.8%). The incidence rose again in the sixth and subsequent years (7-7.7%). Despite a significant occurrence of malfunctions (5.2%) among multiprogrammable pacemakers, the necessity for operative intervention for their correction was low (1.2%). Sensing problems were the most common (57%) and the most likely to be corrected by reprogramming (85%); problems involving loss of capture were less likely to be corrected by programming (38.5%). Battery depletion accounted for only 18% of malfunctions, occurring earliest in the forty-third month of follow-up. Pulse generator longevity of those devices reaching end of battery life during the study period was 68.6 +/- 16.7 months (mean + SD). We conclude that specialized pacemaker follow-up continues to be necessary despite improved pulse generator reliability and longevity. Indeed, with reprogramming, it presently plays an even more important role than in the past. Follow-up should be oriented not only to the detection of battery depletion but also toward a comprehensive surveillance of pacemaker system function.

Permanent triggered antitachycardia pacemakers in the management of recurrent sustained ventricular tachycardia

Permanent pacemakers capable of triggered ventricular stimulation were implanted in 28 patients with a history of sustained ventricular tachycardia or fibrillation. Noninvasive programmed ventricular stimulation was performed on 125 occasions during follow-up periods ranging from 1 to 25 months and was used to assess the efficacy of antiarrhythmic drug therapy, drug or dosage changes and left ventricular endocardial resection. Drug or dosage changes based on noninvasive programmed ventricular stimulation were made in 19 of the 28 patients. In addition, 126 episodes of spontaneous sustained ventricular tachycardia were terminated noninvasively in nine patients. It is concluded that a permanent pacemaker capable of triggered ventricular stimulation is useful in patients with ventricular tachycardia or fibrillation that is difficult to control.

Long-term assessment of unipolar and bipolar stimulation and sensing thresholds using a lead configuration programmable pacemaker

Acute and long-term pacing thresholds were measured prospectively in 74 patients with a unipolar/bipolar multiprogrammable pacemaker. At implantation, mean current threshold was 0.48 +/- 0.16 mA with unipolar mode and 0.55 +/- 0.16 mA bipolar mode (p less than 0.01). R wave amplitude at implantation was 7.78 +/- 2.4 mV with unipolar and 7.67 +/- 2.1 mV in bipolar mode (p = NS). During long-term follow-up (mean 9.3 months; range 3 to 24), no clinically significant differences in pacing or sensing thresholds were observed between bipolar and unipolar configurations. Lead configuration was changed 23 times in 11 patients. Symptomatic myopotential inhibition was corrected in two patients by reprogramming to the bipolar pacing mode. High thresholds and loss of capture were corrected in two patients by reprogramming to the unipolar pacing mode. The remaining configurational changes were made for improved sensing or pacing thresholds. This study documents, in a large group of patients, the equivalence of long-term unipolar and bipolar pacing and sensing thresholds and, in addition, demonstrates that lead configuration programmability offered some advantage in a subgroup of patients and may have prevented reoperation in five patients.

Effect of bradycardia on dispersion of ventricular refractoriness

The effect of bradycardia on dispersion of ventricular refractoriness was evaluated. Refractory periods were measured at 3 right ventricular sites in 16 patients with severe bradycardia (average heart rate 39 +/- 5 beats/min) and were compared with those measured in 11 control subjects, (average heart rate 72 +/- 12 beats/min). Patients with bradycardia had significantly longer effective (377 +/- 36 ms) and functional (421 +/- 39 ms) refractory periods (ERP and FRP) than control subjects (ERP 296 +/- 25 ms, FRP 346 +/- 18 ms) (p less than 0.001). However, dispersion of refractoriness was similar in the 2 groups. Dispersion of ERP was 43 +/- 38 ms and FRP was 48 +/- 35 ms in patients with bradycardia. In control subjects dispersion of ERP was 37 +/- 12 ms, and FRP was 36 +/- 20 ms. Pacing of 120 beats/min significantly decreased ERP and FRP in both groups. Pacing shortened dispersion significantly in control subjects. In patients with bradycardia, pacing failed to significantly decrease dispersion. Compared with control subjects with normal heart rates, patients with bradycardia have longer absolute refractory periods but do not have significantly increased dispersion of refractoriness. Single and double, twice threshold ventricular extrastimuli (S2 and S3) failed to induce ventricular tachycardia in any patient during bradycardia. Bradycardia alone does not appear to be a factor in the induction of ventricular tachyarrhythmias.

Concentration-dependent enhancement of junctional pacemaker activity by verapamil in man

The effects of verapamil on junctional and sinoatrial activity were studied in eight patients with third-degree atrioventricular block and stable junctional rhythms. After intravenous infusion of verapamil three steady-state levels were reached as follows: 34 +/- 16 (SS1), 68 +/- 30 (SS2), and 129 +/- 54 (SS3) ng/ml. At each steady-state level, spontaneous sinus and junctional cycle lengths, QT intervals, junctional recovery times after ventricular pacing, blood pressure, and circulating catecholamine concentrations were measured. These measurements were compared with observations made during an identical protocol (except for the exclusion of verapamil infusions) on a control day. No significant changes were detected in the spontaneous sinus or junctional cycle length, junctional recovery times at a fixed pacing cycle length, blood pressure, or circulating catecholamine concentrations during the control day. In response to verapamil, the mean junctional cycle length decreased from a baseline value of 1320 +/- 239 to 1254 +/- 210, 1199 +/- 214, 1069 +/- 151 msec at SS1, SS2, and SS3 (p less than .01). Sinus cycle length (msec) was unaffected or slightly lengthened from 749 +/- 165 at baseline to 821 +/- 222 at SS1, 831 +/- 222 at SS2, and 817 +/- 175 at SS3 (NS). Mean blood pressure, circulating catecholamine concentrations, and corrected QT intervals were also unchanged by verapamil. Verapamil enhanced junctional pacemaker activity in patients with third-degree atrioventricular block, suggesting that (1) these rhythms originate in cells that are not suppressed by the slow-channel antagonism of verapamil and (2) the acceleration of junctional activity seen in response to verapamil reflects a verapamil effect rather than toxicity.

Conduction system abnormalities in symptomatic mitral valve prolapse: an electrophysiologic analysis of 60 patients

This study examined the site of atrioventricular (AV) block in mitral valve prolapse (MVP). Sixty symptomatic patients with MVP underwent electrophysiologic study; 49 had documented arrhythmias and 28 had syncope. Eight patients had spontaneous second- or third-degree AV block and 10 had chronic bundle branch block. Electrophysiologic study revealed abnormal sinus node function in 8 patients, prolonged HV interval in 10, intra-Hisian delay in 9, and functional bundle branch block in 15. Dual AV nodal pathways were demonstrated in 24 patients. Comparison with 101 similarly symptomatic patients without MVP revealed a greater prevalence of dual AV nodal pathways in the MVP patients. Infranodal conduction abnormalities and dual AV nodal pathways are frequently revealed by electrophysiologic testing in symptomatic patients with MVP.