© 2004 by European Society of Cardiology
Erratum to: Cardiostim supplement
| QT DISPERSION IN HYPERTENSIVE SUBJECTS WITH "NON-DIPPING" A.Musialik-Lydka, B.Sredniawa, T.Zielinska, P.Jarski, A. Sliwinska, Z.Kalarus, L.Polonski I Department of Cardiology, Medical University of Silesia, Silesian Centre for Heart Diseases, Zabrze, Poland The aim of the study: to compare QT dispersion (QTd) and left ventricular hypertrophy (LVH) between hypertensive subjects with preserved (dippers) or absent (non-dippers) night blood pressure fall. Methods: The study investigated 75 pts (43F, aged 52±15) with essential hypertension. ABPM was performed in all pts. Patients were classified as dippers 54 pts or non-dippers 21 pts according to the magnitude of nocturnal BP fall > or < 10% of diurnal values. LVH was confirmed by ECO using left ventricular mass index (LVMI). QTd was assessed based on 12-leads standard ECGs. Results: Dippers and non-dippers had similar 24h systolic and diastolic BP, while nocturnal diastolic BP was less in dippers than in non-dippers (87,8±14,6 vs 93,0±7,7 mmHg; p=0,025). QTd was greater in non-dippers: 51,4±11,5 ms than in dippers: 44,4±13,4 ms; p=0,015. LVMI was significantly greater in non-dippers than in dippers. Conclusions: The lack of nocturnal blood pressure fall in hypertensive patients is a risk factor of LVH and as well as of sudden cardiac death.
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| EFFICACY OF ANTIARRHYTHMIC AGENTS TO PREVENT PAROXYSMAL ATRIAL FIBRILLATION Noro M, Sugi K, Enjoji Y, Moriyama A, Itakura H, Nakae T, Sakata T. Toho University Ohashi Hospital Division of Cardiology Prevention of atrial fibrillation using amiodarone, bepridil, or pilsicainide was studied in total of 120 patients with symptomatic paroxysmal atrial fibrillation. Sixty-eight males and 52 females were involved in these subjects with age ranging between 54 to 82 years old. The patients were initially randomized to receive one of the three drugs, according to the left atrial diameter more than 43mm or not, and also with or without organic heart disease. Three months later from randomization, the drug was switched to the others if paroxysmal atrial fibrillation was observed, or the same agent was continued if atrial fibrillation never recognized. In results, prevention of paroxysmal atrial fibrillation was obtained in 29 of 54 patients (53.7%) with amiodarone, 44 of 69 patients (63.7%) with bepridil, and 27 of 60 patients (45.0%) with pilsicainide. There was a significant difference between bepridil and pilsicainide (P = 0.03). The preventive rate with amiodarone (53.3%) or bepridil (51.4%) were significantly superior to pilsicainide (22.2%) (P = 0.002 and 0.03, respectively) in patients with left atrial diameter over 43 mm. There was no significant difference among three agents on factors related with or without organic heart disease. In conclusions, bepridil, as well as amiodarone, was superior to pilsicainide in preventing paroxysmal atrial fibrillation.
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| CIRCUMFERENTIAL CRYOISOLATION OF PULMONARY VEINS: ACUTE RESULTS AND CLINICAL FOLLOW-UP J. Vogt, J. Heintze, H. Buschler, P. Schwartze, D. Horstkotte Department of Cardiology, Heart Center North Rhine-Westphalia, Ruhr University of Bochum, Bad Oeynhausen, Germany Single pulse isolation of pulmonary veins (PV) is associated with reconducting muscle sleeves and the risk of PV stenoses particularly with radiofrequency technique(RF). We report on circumferential PV isolation with the new Arctic Circler (AC) (Cryocath, Canada). Guided by a 20-pole Lasso catheter, proximal PV isolation was performed using the self-expanding AC with a maximum diameler of 30 mm over 4 min of cryoimpulses(CI) at a temperature of –75°C to –90°C (with N2O). Electrical gaps were closed using a 6-mm tip cryocatheter. Out of 37 patients (P) (26 men, age 58±8 years, refractory to antiarrhythmic therapy, 34 with paroxysmal, 3 with persistent atrial fibrillation(AF)) 24 were treated in a fust attempt, 13 after ablation 3 months ago because of AF recurrence. Out of 133 PV 15 were isolated with the 6-mm tip cryocatheter because of small diameter or few inputs only. 118 PV were isolated with the AC alone in 53% (63 PV), with additional gap closing in 47% (55 PV) (Table). After 5.5±2.5 months 7 of 17 P had no recurrence, 7 P had a marked reduction of AF burden, that is a significant clinical improvement of 82%. Circumferential PV isolation with CI is highly effective. In comparison with RF, no PV stenoses develop and less myocardial sleeves show reconduction.
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| C-REACTIVE PROTEIN AND ACUTE VENTRICULAR TACHYCARDIA IN ARRHYTHMOGENIC RIGHT VENTRICULAR CARDIOMYOPATHY/DYSPLASIA Bonny A, Lacotte J, Hidden-Lucet F, Kingue S, Muna WT, Frank R, Fontaine G-Hopital de la Salpetriere Paris The role of inflammation in the physiopathogeny of atrial fibrillation has been demonstrated. We have tested the hypothesis of an increase in C–Reactive Protein (CRP) blood level in Arrhythmogenic Right Ventricular Dysplasia (ARVD) with recent episodes of ventricular tachycardia (VT). Methods : From January 2001 to February 2003, we prospectively studies 25 ascertained ARVD patients referred with VTs or infundibular premature beats. Exclusion criteria were recent infectious disease (< 1 month) and ischemic heart disease. Cardiac tests included ECG, holter monitoring, SAECG, coronary angiography, left and right ventricular angiography. CRP was tested in all patients on admission. Two different methods were used to analyse the serum level of CRP: immunobidimetric integra 400 Roche (18/25 patients) and turbidimetric petina/bade Behring(7/25 patients). Finally, 19 patients were retained. Results : 5 patients had elevated CRP (CRP+), 7 had recent documented VT (VT+), 5 had CRP+ and VT+, 2 had CRP– and VT+, 0 had CRP+ and VT– Fisher's exact test was used to analyse the link between CRP and recent VT (p= 0.005; Phi coefficient = 0.764). Kruskall-Wallis test was used to analyse the influence of delay between VT and CRP test and right ventricular changes in angiography (p= 0.724). We found a correlation between CRP elevation and recent VT, but the sequence of events is still to be specified. No influence of degree of dysplasia was found. Conclusion: Inflammation suggested by the rise of CRP, plays an important role in the induction of ventricular tachycardia in arrhythmogenic right ventricular cardiomyopathy/dysplasia.
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| PULSED BIPHASIC WAVEFORM REQUIRES LESS ENERGY THAN COMMON MONOPHASIC WAVEFORM FOR CONVERSION OF ATRIAL TACHYARRHYTHMIAS Fontaine G, Trendafilova E, Daskalov Y, Schmid HJ, Cansell A, Schiller AE - Hopital Salpétrière Paris/National Heart Hospital Sofia Bulgaria Pulsed biphasic (PB) waveform developed for external ventricular defibrillation requires less energy than common monophasic (Mn) waveform. The aim of this study was to test the hypothesis that conversion of atrial fibrillation (AF) or flutter (Fl) requires less energy with PB than Mn waveform. Method : The study population consisted of 222 patients (64% male) mean age 57±10 (27–83) mostly suffering from AF (66%). All patients failed a mean of 1.5 antiarrhythmic drugs. Arrhythmias occurred during the year (98%), the 3 months (75%) and 2 days (10%) prior to conversion. Etiologies included : valvular disease 44%, atrial dilatation (echo) 32%, coronary disease 10%, none 5%, dilated cardiomyopathy 2.7%, other 1.8%. However, 37% had clinical signs of heart failure at the time of conversion. A sequence of increasing energy shocks was delivered until a stable sinus rhythm was obtained. The starting energy was determined from body size. Results : Energy required for AF conversion was 133 versus 225 Joules ; ratio 1.69 (p<0.0001). Energy required for Fl conversion was 76 versus 208 Joules ; ratio 2.73 (p<0.0001). Less CK (x/3.5) was released and less side effects were observed with the PB waveform, in terms of block, bradycardia and arrhythmia post shock therapy. Failure rate (10%) was the same with either of the two waveforms. Conclusion : This is the first study of a large series of patients reporting the benefit of proper waveform selection for the treatment of atrial tachyarrhythmias. Half of energy level for atrial fibrillation (1/3 for flutter) was obtained and less side effects were observed with the new pulsed biphasic waveform as compared to the common monophasic waveform for conversion of atrial tachyarrhythmias.
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| QT DYNAMICS DEPENDENCE ON CIRCADIAN PATTERN AND SEX Beata Sredniawa , Agata Musialik-Lydka , Piotr Jarski, Zbigniew Kalarus, Lech Polonski I Department of Cardiology Silesian Medical School, Silesian Center for Heart Diseases, Zabrze, Poland Purpose of the study: to assess QT dynamics in healthy subjects depending on sex and circadian pattern. Methods: The study group consisted of 50 healthy subjects (25M, aged 32±6), in whom 24-hour Holter digital monitoring was done and QT interactive "beat by beat" analysis was performed. Mean QT and RR intervals were measured from entire recordings. In QT dynamics assessment QT/RR linear regression was performed and calculated slopes: from entire 24-hours (Sa), day (Sd), night hours (Sn), women and men. Results: Mean value of (Sa) was 0,17±0,03. The slope was significantly steeper during day than night hours: Sd: 0,13±0,03 vs Sn: 0,09±0,03; p<0,001. The slope was significantly steeper in women than in men from 24 hours: 0,18±0,03 vs 0,16±0,03; p=0,006 and day hours: 0,14±0,03 vs 0,12±0,03; p=0,04. Conclusions: QT dynamics characterizes circadian pattern and sex differences. The latter can be responsible for susceptibility of women to torsade de pointes during the treatment with drugs that prolong QT interval.
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| INFLUENCE OF PACEMAKER PARAMETERS ON AF SUPPRESSION PERFORMANCE 1Joseph Alonso, MD, 2Anil Chhabra, MD, 3Bassam Al-Joundi, MD, 4Kishor Vora, MD, 5Zaffer A. Syed, MS, 1Ocala Regional Medical Center, Ocala, FL, 2Willis Knighton Health Systems, Shreveport, LA, 3Christian Northeast Hospital, St. Louis, MO, 4Owensboro Heart and Vascular, Owensboro, KY, 5St. Jude Medical, Sylmar, CA. Background: AF Suppression (AFS) has proven to reduce symptomatic atrial fibrillation (AF) burden. Programming pacemaker parameters to optimize AFS performance has yet to be evaluated. Methods: This retrospective, multicenter study included 143 pts (48% male, 75±9 yrs). All patients were programmed with AFS ON, and auto mode switch(AMS) data were obtained during follow-up. Base rate(BR), maximum sensor rate(MSR), and post ventricular atrial refractory period(PVARP) were analyzed for their effect on AMS duration and AMS frequency. Percent atrial pacing(PAP) was evaluated for its predictive value of AMS. Results: Correlation analyses showed that BR, MSR, and PVARP were not significantly related to AMS duration. A strong correlation exists between MSR and AMS frequency (r=0.17, p=0.015). AMS frequency was significantly lower in patients with MSR?115 ppm than MSR?120 ppm (1.20±4.19 vs. 15.05±0.03 AMS episodes/day, p=0.038). PAP is strongly correlated with AMS duration (r=–0.22, p<0.01) and frequency (r=–0.30, p<0.001). Conclusion: BR and PVARP do not influence AFS's effectiveness in reducing AMS episodes. Programming parameters to maintain high PAP reduces AMS frequency and duration. Prospective examination of optimizing parameters to improve AFS performance is warranted.
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| AT 500 PACEMAKER IN ADOLESCENTS WITH OPERATED CONGENITAL HEART DISEASE M.S.Silvetti, G.Grutter, A.De Santis, F.Drago. Bambino Gesù Hospital, Rome, Italy. Brady-tachy syndrome frequently occurs in pediatric patients (pts) following surgery for complex congenital heart diseases. Prevention and treatment of intra-atrial reentry tachycardia (IART)may be difficult, thus anti-brady, anti-tachy pacemaker (PM) was evaluated in 16 pts, after Mustard operation (9), Fontan (6), AV canal repair, aged 17+/–9 (mean+/–SD) years, symptomatic for IART, who underwent Medtronic AT 500 PM implantation, with transvenous or epicardial leads (8 pts each). Pacing mode was DDD-DDDR (5–11 pts), lower/upper rate were 79+/–3/151+/–14 bpm; preventions were on in all pts, anti-tachy pacing (ATP) on in 10 pts: burst+ A-S1 88+/–6%, S1-S2 84+/–8%, S2-S3 17+/–5 ms, 6+/–3 sequences; burst+ A-S1 85+/–8%, S1-S2 80+/–5%, S2-S3 18+/–4 ms, 7+/–3 sequences; ramp A-S1 91+/–4%, 7+/–3 sequences. Follow up is 13.5+/–9.9 months: 414 IART (cycle length)were detected in 5 pts, ATP success rate was 86% (153/178). Not treated IART were due to short duration or sporadic atrial undersensing. Anti-brady, anti-tachy pacing seems effective in prevention and treatment of IART in these pts.
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| USEFULNESS OF A RADIOFREQUENCY THERMAL BALLOON CATHETER FOR THE TREATMENT OF ATRIAL FIBRILLATION Shutaro Satake, Hisroshi Sohara, Kazushi Tanaka, Yoshio Watanabe. Shonan Kamakura Genaral Hospital Puropose- The present study was designed to evaluate the usefulness of a radofrequency thermal balloon cathetr (RBC)for the treatment of atrial fibrillation(AF). Methods- We treated 30 patients with drug-resistant AF,using RBC for circumferential ablation around the pulmonary vein ostium(PVO). The elastic balloon was wedged at the atrial region all around the PVO through trans-septal approach. A very high frequency current(13.56 MHz) was applied between the coil electrode inside the balloon and the electric plate on the body for 2–5 minutes, keeping the balloon temperature between 60 and 75 degrees Celsius. Results-Successfull isolation was acheived in 29 of 30 left superior PVO, all of 30 right superior PVO, 24 of 25 left inferior PVO and 16 of 17 right inferior PVO. Total procedure time was 2.5(1.5–3.0)hours. Twenty-four of 30 patients were free from AF without anti-arrhythmic drugs, and the remaining patients had markedly improvement of symptome during 9–18 months, without complication such as PV stenosis or embolism. Conclusion- RBC is a safe and useful devise for the treatment of AF.
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| DELAYED DEFIBRILLATOR TEST (DT) IN BIVENTRICULAR-ICD (CRT-D): A SAFE APPROACH M.Gasparini,S.Simonini,P.Galimberti,F.Costa ; Istituto Clinico Humanitas Milano—Italy BACKGROUND: Defibrillation test (DT) at the end of CRT-D implantation can theoretically expose to the risk of micro/macro dislodgement of left ventricular lead. Until now it's no clear if a delayed defibrillation test could be feasible and safe in these severe situations. MATERIAL AND METHODS: 133 consecutive pts (mean age 64 ys, mean NYHA class 3,0, mean EF 28%) who underwent CRT-D implantation from 1999 to 2003 were analysed. In the first 17 pts a DT was performed at the end of CRT-D implantation. In 4/17 dislodgement of the left ventricular lead after defibrillation test occurred (in 3 cases repositioning of LV lead was necessary). In the following 116 consecutive pts we avoided DT at the end of CRT-D implantation, performing DT only 2 months later. RESULTS: In 111/116 (95,7 %) pts, VF was correctly interrupted at the first shock delivered (mean energi 21,8 J). In 5/116 VF was interrupted at the second attempt at maximal energy ; in these five cases a third attempt at the same level of energy was effective too. No deaths or device-related complications occurred in the 2 months before re-hospitalization. Meanwhile, in 4/116 pts a spontaneous ventricular arrythmia (in 2 cases VT and VF in other 2) was correctly diagnosed and treated by the device without any previous defibrillation test. CONCLUSION: Our experience shows that DT performed 2 months after CRT-D implantation is safe and feasible (100% success, 96% with a margin of 10 joules, 4% with a double shock at maximal energy). Possible explanation for such a high success rate may be related to the improvment of clinical conditions and hemodynamic status after CRTD implantation.
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| CRYOABLATION OF PARAHISSIAN SUPRAVENTRICULAR TACHYCARDIAS IN CHILDREN F.Drago, G.Grutter, A.De Santis, M.S.Silvetti. Bambino Gesù Hospital, Rome, Italy In order to reduce complications in the treatment of the reentry circuits located near the His bundle, we evaluated the efficacy and safety of the transcatheter cryomapping and cryoablation in children. Nineteen patients (pts)(mean age 13+/–3 years) were selected. Nine pts had AV nodal reentrant tachycardia (AVNRT). Ten pts had accessory pathway (AP), 6 with a right anteroseptal and 4 with a right midseptal AP. After identification of a possible site of ablation, the cryomapping was performed by cooling to –30°C in order to verify the occurence of an AV block. Cryoablation was successful in 17 pts (89,4%) and unsuccessful in 1 with AVNRT and 1 with a concealed AP. Cryoapplications were delivered with a mean temperature of –74+/–3°C (mean duration 6+/–1,5 min). No early or late complications were observed. Tachycardia recurred (follow-up range: 1–12 months)in 3 pts (17,6%). In conclusion cryoablation seems to be safe and effective in the treatment of reentry circuits located near the AV junction in pediatric pts.
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| IS THE DIAGNOSTIC YIELD OF 24 - HOUR HOLTER MONITORING DIFFERENT BETWEEN PATIENTS WITH FREQUENT VS. INFREQUENT PALPITATIONS? Arie Militianu, Yariv Salit. Zvulun and Carmel Medical Center Medical Centers , Haifa, Israel. Background: Twenty- four hour Holter monitoring (HM) is frequently used to evaluate patients (pts.) with palpitation. Recently it was recommended to use those devices particularly if symptoms occur daily or almost daily. The aim of this prospective study was to validate this statement by comparing the diagnostic yield (defined as symptoms with recorded arrhythmia i.e. true positive + symptoms with normal ECG i.e. true negative) of HM in pts. with frequent vs. pts. with infrequent symptomatic palpitations. Results: Out of 514 consecutive ambulant outpatients referred for HM during one year, records of 453 patients (pts.) were available for analysis. Two hundred forty one (47%) were pts. with unexplained palpitation. One hundred sixty six (69%) were female, the mean age was 58 (range 13–87) and 69 (29%) had organic heart disease. Of those 453 pts., 119 (49%) had daily symptoms (group I); 59 pts. (24%) had symptoms less then daily but at least once a week (group II); 63 pts. (27%) had less then weekly symptoms (group III). For the diagnostic yield see table. Conclusion: 1. We found no difference in the diagnostic yield of HM in pts. with daily palpitation, compared with those with infrequent symptoms. 2. HM is a better test for exclusion of arrhythmia as the cause of palpitation, then for the diagnosis of the symptoms. The diagnostic Yield True True Diagnostic Positive Negative Yield GroupI (N=119) 12 pts.(10%) 32 pts.(27%) 37% GroupII (N=59) 7 pts.(12%) 15 pts.(25%) 37% GroupIII (N=63) 4 pts.(6%) 18 pts.(28%) 34% Total (N=241) 23 pts.(9%) 65 pts.(27%) 36%
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| ALTERED EPIDEMIOLOGICAL PATTERN OF SUDDEN CARDIAC DEATH IN AMI SURVIVORS WITH OPTIMIZED THERAPY Makikallio TH, Barthel P, Schneider R, Bauer A, Tapanainen JM, Schmidt G, Huikuri HV - University of Oulu, Finland Background: Optimal revascularization and medical therapy may alter the epidemiological pattern of sudden cardiac death (SCD). We tested the hypothesis that optimized therapy is associated with reduced SCD rate in the current treatment era of acute myocardial infarction (AMI). Methods and Results: A total number of 2130 consecutive pts (mean age 60±10 years) with an AMI from two European centers (Germany and Finland) was included in the study. In this population, 1004 pts (47%) were treated according to current practice guidelines, i.e. revascularization 70%, beta-blockers 94%, ASA 94%, statins 69% and ACE-inhibitors 74%), while 1126 pts (53%) received non-optimized treatment, defined as lack of any of the treatment mentioned above. During the mean follow-up of 2.9±1.3 years, the incidence of SCD was significantly lower among those with optimized treatment (1.2%; annual incidence 0.4%) than among those without (3.6%; annual incidence 1.4%, p 0.01). In the multivariate analysis after adjusting for age and ejection fraction, the difference between the SCD rate remained significant between the groups (p 0.05). The treatment strategy that had the most significant impact on differences in the SCD rate was revascularization therapy, the hazard ratio of SCD being 2.1 (95% CI, 1.2–3.7, p 0.01) for SCD among non-revascularized pts. Conclusions: Incidence of SCD is low in the modern treatment era of patients after an AMI. Coronary revascularization seems to have a large impact on altered epidemiological pattern of SCD.
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| A NEW ALGORITHM FOR VENTRICULAR AUTOMATIC CAPTURE DETECTION IN ICDS Johannes Sperzel1. Mauro Biffi2, Thorsten Schwarz1, Andreas König3,Roger Willems3, Yanting Dong4, Scott Meyer4, Giuseppe Boriani2.1Kerckhoff Klinik, Bad Nauheim, Germany, 2University Hospitals, Bologna, Italy, 3Guidant Europe, Diegem, Belgium, 4Guidant Corporation, St.Paul, MN, US In this study a new algorithm for automatic capture verification on ICD lead systems has been evaluated. The algorithm is based on evoked response detection using the sensing vector RV-coil to Can. Combined signal amplitude and timing information for the discrimination of capture (C), fusion (F), and non-capture (NC) beats are used for classification. Method: The study was performed during new ICD implant or device replacement. Ventricular step-down threshold testing was conducted with AV-delay=60ms in DDD patients or intrinsic rate +10bpm in VVI patients. Surface ECG and intracardiac electrograms were recorded on a wideband pacing and data acquisition system. The signals were then downloaded to a computer system, and each beat was independently classified by visual examination of the surface ECG morphology and by the algorithm. The performance was evaluated by comparison of the classification results. Results: Data from 27 patients (22 male/5 female; 64,0±11.9 years) were studied, the device and lead demographics were: 18 DDD/9 VVI; 16 dedicated BP/11 integrated BP leads;19 acute/8 chronic (3.5±2.1 years) leads. A total of 1252 beats were analyzed: 1073 C beats, 73 F beats, and 106 NC beats. Correct detection rates for C, NC, and F beats were 95.2%, 98.1%, and 100%, respectively. Two NC beats (1.9%) in VVI mode were declared as F because of intrinsic activities. Fifty-one C beats (4.8%) were misclassified as F due to temporal phase shifts in the ER signal. Conclusion: The results indicate that a highly sensitive capture detection algorithm can be implemented using the RV coil to Can electrogram.
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| TELEMEDICINEIN CARDIOVERTER DEFIBRILLATOR RECIPIENTS: A BENEFIT RELATED TO DISTANCE FROM INSTITUTION L Fauchier, N Sadoul, C Kouakam, F Briand, M Chauvin, D Babuty, J Clementy. CHU Tours, Nancy, Lille, Besançon, Strasbourg, Bordeaux, France. Home monitoring (HM) may induce a reduction in the number of annual visits and cost in cardioverter defibrillators recipients (ICD). Methods. In a french multicenter database including 502 patients, conventional follow-up (FU) cost was calculated for non-HM and was compared to the expected cost for specific FU of HM ICD. Calculations included number of visits, with medical cost (Physician's fees, ECG, specific ICD control) and transportation cost. Results. The distance between home and the institution performing follow-up was 69±57 kilometers (km). For each visit, the cost for transportation (professional health vehicle in sitting position without physician) was 121 euros. Medical cost was 94 euros leading to a mean total cost of 215 euros. HM may suppress up to 2 visits per year (from 4 to 2 visits or from 3 to 1 visit per year). Over the 5 years of expected life duration of the device, the reduction in the costs for FU visits can be evaluated at 2149 euros. Considering an extra cost of 1200 euros for the HM device, a cost benefit will be reached after a mean of 33.5 months. Delay to cost benefit of HM ranged from 17.4 months for patients living > 150 km from institution to 52.2 months for those living < 50 km from institution. If HM ICD is limited to patients living more than 50 km from the referring institution, the mean reduction in cost over a 5 year period will be 2722 euros with a cost benefit reached at 26 months. Conclusion. Transportation is the major component of cost in the FU of ICD patients. HM may substantially reduce this cost, particularly when the distance between home and the institution performing FU exceeds 50 or 100 km.
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| A BENEFIT ON RECURRENCE OF EPISODES AND BURDEN OF ATRIAL FIBRILLATION USING PACEMAKER DIAGNOSTICS L Fauchier, F Briand, D Lellouche, JP Camous, JP Darmon, J Lévy, F Quennelle, FX Soto, T Lavergne, P Poret, C Pelade, D Babuty. Cardiologie B, CHRU Tours, France. The efficacy of prevention pacing therapies of atrial fibrillation (AF) is being evaluated in several studies but the programming of the device is usually predefined. A strategy of individual management of paroxysmal AF with diagnostic tools has still not demonstrate its benefit. Methods: In a multicenter prospective study, 48 patients with documented AF and pacing indications, received a Selection DDDR (Vitatron, NL). Antiarrhythmic agents were prescribed in 90% of the patients. AF1.0 was programmed to document AT burden, onset daily distribution, duration, premature atrial beats before onset and onset of AT episodes. After follow-up (FU) at 3 months using AF 1.0, therapeutic adjustments were performed in 53% of the patients (pacing parameters 38%, preventive pacing algorithm 38 %, medication 19 %, others 5%). The evaluation of the efficacy of management using AF 1.0 was evaluated at the 6-month FU, each patient being its own control. Results: AF recurrences were documented in 69% of the FU. At 6-month FU, median value of AF burden was reduced (0.85% vs 1.35%, –37%) as was median values of AF duration (12.9 hours vs 24.8 hours, –48%) and of number of AF episodes (5 vs 8, –38%). The percentage of patients with no AF recurrence increased from 25% at the 3-month FU to 33% at the 6-month FU (p=0.008). Conclusion: A strategy of therapy of AF guided by AF 1.0 diagnostic functions using specific types of therapeutic adjustments (pacing parameters, preventive pacing algorithms and/or medication) is associated with a decrease in the percentage of patients with recurrence of AF and with an overall decrease in AF burden and number of AF episodes.
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| IMPROVED CLOSED-LOOP STIMULATION - A MULTICENTER STUDY
C.R.M. Gomes, O.T. Greco*, J.J. Sobrinho
Hospital Anchieta, Brasília, Brazil, *IMC, S.J. do Rio Preto, Brazil, Purpose: The Closed-Loop Stimulation (CLS) method uses intracardiac impedance to detect myocardial contractility changes for physiologic rate adaptation. An enhanced method, that overcomes the limitation of previous systems by evaluating ventricular paced and sensed beats, was investigated in a multicenter study. Methods: 27 pts. (64±14 yrs.) with a Protos DR/CLS pacemaker (Biotronik, Germany) were enrolled. The heart rate during a CAEP exercise protocol was correlated with a predicted rate from a linear Wilkoff model. The slope of the regression line was determined. The adaptive rate during postural changes was evaluated. The circadian rate variation was determined from 24h Holter recordings. Results: 14 pts. completed 4 or more load stages. The mean regression slope was 0.85 with a 95% confidence interval of [0.72, 0.98]. The average pacing rate increase on a transition from supine to standing position was 12.9 bpm. The average rate increase of the control group (7 pts. with sinus rhythm) was 9.3 bpm. The mean maximum rate increase observed upon rolling over in supine position was 3.2 bpm. The mean circadian rate difference was 9.3 bpm (35 days in total), where the rate difference for each patient was the difference between the average day and night rates. Proper rate adaptation was observed on ventricular paced and sensed beats. Conclusions: The treadmill results are well within the commonly accepted range. The orthostatic challenge demonstrates adequate rate support in the absence of physical exercise. The enhanced CLS method is safe and effective and behaves physiologically.
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, J.J.E. Reynoso
, M. Lippert§, D.F. Hastings§, G. Czygan§
| POSITIVE EFFECTS OF CARDIAC RESYNCHRONIZATION THERAPY ON LEFT VENTRICULAR GEOMETRY, PERFUSION AND CONTRACTILITY J.H. Geertman, A.R. Ramdat Misier, W.P. Beukema, A. Oostdijk, P. P. Delnoy, M.J. de Boer, F. Zijlstra - Zwolle, The Netherlands Purpose: Gated single photon emission computed tomography allows the evaluation of regional left ventricular (LV) perfusion, function and end-diastolic volume (EDV) during one single acquisition. We evaluated the effects of cardiac resynchronization therapy (CRT) on regional perfusion and contractility in early and late-activated LV regions during CRT. Methods: Seventeen patients, mean age 57 years, with idiopathic dilated cardiomyopathy (IDCM) and LBBB underwent CRT. Target site for pacing was the late-activated lateral LV wall. Data acquisition was performed baseline, 2 days and 3 months after CRT. Semi-quantitative analysis of myocardial perfusion and function (wall motion and thickening) was performed for each LV segment using a 4-point scale (0,1,2,3). Results: EDV decreased from 301 ml (baseline) to 272 ml (2 days CRT) to 242 ml* (3 months CRT). Global LVEF increased from 19% (baseline) to 22% (2 days CRT) to 27%* (3 months CRT). Perfusion of the septal wall increased from 0.9 (baseline) to 1.7 (2 days CRT) to 2.0* (3 months CRT). Wall motion of the septal wall increased from 0.3 (baseline) to 1.2 (2 days CRT) to 1.9* (3 months CRT). LV septal wall thickening increased from 0.2 (baseline) to 1.0 (2 days CRT) to 1.9* (3 months CRT). *P is less than 0,05 (3 months CRT versus baseline). The LV lateral wall showed perfusion score of 1.6, wall motion score of 1.3 and lateral wall thickening of 1.1. These parameters did not change during CRT. Conclusion: In selected patients, CRT initially improves myocardial function and perfusion in early-activated (septal) regions. These positive effects increase over time, and is paralleled with an increase of LV ejection fraction and a reduction of LVEDV.
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