© 2004 by European Society of Cardiology
Abstracts
| 4-1 PULMONARY VEIN ISOLATION USING ULTRASOUND BALLOON ABLATION FOR TREATMENT ATRIAL FIBRILLATION WITHOUT RISK OF PULMONARY VEIN STENOSIS Ma CS, Liu XP, Dong JZ, Liu X, Wang JA, Fang DP, Liu XQ, Wang J. Department of Cardiology, Beijing Anzhen Hospital, Beijing 100029, P. R. China Objective: Pulmonary vein (PV) stenosis following radiofrequency catheter ablation (RFCA) for curing atrial fibrillation is a serious complication (incidence from 1% to 10%). The impact of different ablation energy on the incidence of PV stenosis has not been well described. Aim of the study was to determine the long-term safety and efficacy of anatomical PV isolation with an ultrasound balloon ablation system (IBI Inc.). Methods: Circumferential ultrasound balloon ablation of both upper PVs and left inferior PV were performed in 47 patients (mean age 55±10 years; 38 males) with symptomatic and drug refractory paroxysmal atrial fibrillation. The procedural endpoint was PVs isolation. A contrast-enhanced magnetic resonance angiography (MRA) of PVs were performed before, at 1 week and 6 months after the ablation procedure to define the anatomy of PVs and to measure the diameter of ostium of each PVs in all patients. Results: Of 137 PVs targeted, 101 (73.7%) were successfully isolated. After a mean period of 18.8±9.2 (8{small tilde}30) months of follow-up, atrial fibrillation was completely eliminated in 19 patients (40.4%) without antiarrhythmic drug. There was no acute PV stenosis or thrombosis observed in any treated PVs based on the venogram performed during the procedure. At 1 week and 6 months after the procedure, the MRA of PVs showed no evidence of stenosis or even mild narrow (<25% diameter) in any patients. Conclusions: Ultrasound balloon ablation can isolate PV with an acceptable efficacy profile and without PV stenosis. Key word Atrial fibrillation Ablation Pulmonary vein stenosis
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| 4-2 PREDICTORS OF CONVERSION TO SINUS RHYTHM DURING CATHETER ABLATION OF PERSISTENT ATRIAL FIBRILLATION McElderry HT, Lan DZ, Epstein AE, Plumb VJ, Kay GN. University of Alabama at Birmingham. In some patients with persistent AF, catheter ablation encircling the pulmonary veins (PVs) restores sinus rhythm (SR) without requiring cardioversion (CV). In this study we characterized features of the ECG and intracardiac electrograms that predicted conversion to SR during ablation. Methods: 33 pts (male 20, mean age 55yrs) with persistent AF referred for catheter ablation were studied. AF waves were defined as coarse in an ECG lead if the mean amplitude was >0.1 mV. If <0.1 mV, then AF was defined as fine. Intracardiac electrograms in the coronary sinus (CS) were defined as organized if there was a repeating pattern of activation with discrete isoelectric segments. Patients were divided into two groups based on whether AF terminated during ablation: In Grp A (15 pts), SR was restored, and in Grp B (18 pts) AF persisted after encircling all 4 PVs. Results: AF was coarse in more ECG leads in Grp A than B (9.4+6.5 vs. 3.8+6.5, P<0.001). If AF was coarse in >10 leads, all pts converted to SR (9/9); if AF was coarse in <6 leads, 13 of 14 pts required CV. In lead II, the average fibrillation wave amplitude was 0.19+0.04mV in Grp A and 0.09+0.02mV in Grp B (P<0.001). The mean CL in the CS was longer in Grp A than B (209.8+694ms vs. 169+792ms, p=0.007) and the CS activation pattern was organized in 10/15 pts in Grp A vs. 5/18 pts in Grp B (p=0.057). The CS electrograms included an isoelectric segment in 11/15 pts in Grp A and 5/18 pts in Grp B (p=0.24). Conclusions: Patients with persistent AF that converts to SR during ablation have more coarse AF, a more organized CS activation pattern, and discrete isoelectric intervals. These findings suggest a longer wavelength and fewer atrial wavefronts in these patients.
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| 4-3 NEW INSIGHTS INTO ELECTRICAL CONNECTIONS BETWEEN PULMONARY VEINS DEMONSTRATED BY EXTENSIVE ENCIRCLING ISOLATION OF IPSILATERAL PULMONARY VEINS Y. Nagata, M. Goya, K. Suzuki, Y. Takahashi, A. Takahashi, Y. Iesaka, Tsuchiura Kyodo Hospital, Japan Electrical connections between contiguous pulmonary veins (PVs) (inter-PV connections) might be a cause of difficult PV isolation in patients with paroxysmal atrial fibrillation (AF). To avoid complexity and risk of PV narrowing, we developed a new method of extensive encircling isolation of ipsilateral PVs (EEI), guided by simultaneous recordings from 2 decapolar circular catheters placed in both the ipsilateral upper and lower PVs. We assessed the prevalence of inter-PV connections during EEI. Methods: Sixty-seven consecutive patients with paroxysmal or persistent AF (57 males, 53±10 years) underwent EEI. Radiofrequency (RF) energy was administrated in the junction between left atrium (LA) and PVs. The septum wall between the contiguous PVs was excluded from RF delivery. After isolation of ipsilateral PVs, intra-PV pacing was performed. Results: In 45/133 pairs of successfully isolated ipsilateral PVs (left 23/67; 34% and right 22/66; 33%), contiguous PVs were disconnected simultaneously by final RF delivery (indirect evidence of inter-PV connections). Direct evidence of inter-PV connections were demonstrated by follows; 1) intra-PV pacing associated with contiguous PVs capturing was shown in 17 left and 12 right ipsilateral PVs, 2) dissociated PV spikes encompassing upper and lower PVs emerged spontaneously in additional 2 left and 3 right ipsilateral PVs. Conclusions: Inter-PV connections were estimated from indirect and direct evidence to be present nearly in 30% of paired PVs. EEI using simultaneous monitoring of ipsilateral PVs makes the detailed anatomy of the connection between LA and PVs clear, and can conquer the complexity and risk in PV disconnection.
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| 4-4 SIGNALS RECORDED AT OSTIA OF THE PULMONARY VEINS CAN BE CLEARLY DISCRIMINATED BY DIFFERENT-SITE PACING AND ABLATION IN PATIENTS WITH PAROXYSMAL ATRIAL FIBRILLATION Jian Chen, Per Ivar Hoff, Knut Ståle Erga, Ole-Jørgen Ohm, MD, PhD. Haukeland University Hospital, Bergen, Norway Introduction: The pulmonary vein (PV) isolation has been used to treat patients with paroxysmal atrial fibrillation (PAF). It may be difficult to differentiate PV potentials from atrial signals. We sought to interpret the recordings made in the PVs during ablation and by different-site pacing. Methods and results: This study consisted of 63 consecutive patients with PAF (50 men, 13 women, mean age 53± 11). The numbers of the PVs studied are listed in the table. 20 PVs were excluded from the study because ablation was performed during PAF. A Lasso catheter was positioned in the ostia of the PVs for recording. A multi-electrode catheter and another ablation catheter were positioned in the coronary sinus (CS) and left atrial appendage (LAA) respectively for pacing. Another 4-polar electrode was placed in between the right atrium and the superior vena cava (SVC) for recording and pacing. There were two types of signals recorded at the ostia of the PVs: double potentials or one fractional potential in the left PVs (during CS pacing) and the right PVs (in sinus rhythm). The timing of the first signal of double potentials was the same as that of the potential recorded in LAA (for the left PVs) or in the SVC (for the right PVs) either during LAA/ SVC pacing or in sinus rhythm. The second potential was delayed in some patients and abolished in all patients by PV ostimn ablation.
Conclusions: The recordings at the ostia of the PVs consist of the PV potentials, the far-field potentials of the LAA (the left PVs) or SVC (the right PVs) and the local atrial potentials. The relations and intervals of these potentials could be revealed by pacing in the LAA or in the SVC.
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| 4-5 DIFFERENTIAL SITE ATRIAL PACING TO IDENTIFY PULMONARY VEIN POTENTIALS Richard Klein, Univ of Utah and VA Medical Center, Salt Lake City, UT Craig Swygman, Boston Scientific, San Jose, CA Identification of pulmonary vein potentials (PVP) is critical to identifing myocardial segments in PVs for PV isolation as therapy for atrial fibrillation (AF). Because this can be difficult during sinus rhythm pacing from different atrial sites might improve PVP identification. Methods: During ablation for PV isolation, pacing and premature stimulation (PES) were performed from the distal coronary sinus (CS), posterior left atrium (LA), LA appendage (A) and right atrium (RA). PVs were mapped with a basket catheter positioned at the PV orifice. In 14 pt a total of 43 PVs could be mapped and the pacing protocol completed. Results: Pacing and PES from the posterior LA most consistently separated PVPs in both right and left PVs.Distal CS pacing was not consistent in separating PVPs, possibly due to variations in CS-LA electrical connections. Pacing from the RA was least useful in identifying PVPs in both right and left PVs; PVPs were not separated with RA pacing in any of the left PVs. Programmed PES at all sites was more effective in separating LA and PV potentials than atrial pacing; decremental PES always resulted inprolongation of local LA-PVP timing. In selected pts, pacing from the interatrial septum was helpful in differentiating local atrial potentials from PVPs in the right inferior PV. Conclusion: Pacing from different left atrial sites can be useful in differentiating local atrial potentials from true PVPs during ablation for PV isolation. The most effective site was the posterior LA; premature stimulation was more effective in separating PVPs from local atrial potentials.
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| 4-6 INDIVIDUALIZED AF ABLATION AS GUIDED BY NON INDUCIBILITY P. Jaïs Different strategies have been reported for ablation of paroxysmal AF (PAF), using pulmonary vein isolation (PVI) ± left atrial (LA) linear lesions but none have been individually tailored. Methods 46 Patients (7 F, 53±10 yrs) undergoing ablation of PAF (7±7 yrs) were studied with the end point of non inducibility (NI). PVI and cavotricuspid ablation were first performed while further linear ablation was guided by the inducibility of AF. Sequential linear lesions (either at mitral isthmus or LA roof or both) were performed up to achieving NI of AF or flutter. Inducibility was assessed by pacing (20 mA) at maximum rate allowing 1:1 atrial capture from both appendages and coronary sinus. Results Before ablation, AF was present spontaneously in 13 pts (35%). 24 pts underwent only PVI and cavotrivuspid ablation as AF was rendered NI. Linear ablation was required in 22 pts (48%). In 17, a single linear lesion was performed for inducible AF (16) or peri right veins flutter (1) involving mitral isthmus in 12 or LA roof in 5. Linear block was achieved in all and resulted in NI. In 5 pts, persisting inducibility (2) or fibrillation (3) after the initial linear lesion required a second linear lesion resulting in linear block in 4/5 roof and 3/5 mitral isthmus. After the second linear lesion, AF and left flutter were still inducible in 1 each. At the end of this staged approach, NI was achieved in 44/46 (96%). Early reablation was performed in 10/46 (22%) for PV recurrence (5), non PV foci (3) and peri mitral flutter (2). With a follow-up of 6±5 months, 42/46 (91%) pts were free of AF without antiarrhythmic drugs. Conclusion An individually tailored approach aiming to achieve NI results in successful ablation in 91% of PAF: ablation target were limited to PVI in 52% of the patients, and required additional linear lesions in the remaining.
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| 9-1 ICD LEADS. HOW OFTEN DO THEY FAIL AT LONG TERM? TN MAOUNIS, G POULOS, E EVGENIADOU, K KATSAROS, AS MANOLIS, DV COKKINOS, 1st Dpt of Card, Onassis Cardiac Surg Ctr, Athens, Greece The implanted defibrillator leads (IDL) are complex leads used both for pacing and sensing the ventricle and for defibrillation. The purpose of this study is to evaluate the long term performance of IDL. The long term performance of the IDL was evaluated in 69 patients (pts) who had defibrillators implanted in our institution, who had a regular follow-up for at least 36 months and in whom the performance of the IDL was normal during this initial period. The underlying heart disease was coronary artery disease in 52, dilated cardiomyopathy in 6, hypertrophic cardiomyopathy in 4, and other diseases in 7. Mean age of the pts was 63+14 years and mean ejection fraction 35+9%. There were 62 men and 7 women. Mean follow-up was 68+23 months. During this extended follow-up in 60 pts the IDL continued to function normally. In 9 pts (13%) lead related problems were encountered. In two pts oversensing due to lead fracture was noted resulting in inappropriate shocks. In two other pts oversensing occurred only after defibrillator shock. In one pt high pacing threshold, low pacing impedance and low defibrillation impedance developed 34 months after implantation. In one pt exteriorization of the lead occurred 36 months after implantation. In 1 pt high defibrillation threshold and oversensing after the shock was found at replacement. Finally 2pts had a unipolar ventricular pacing and sensing IDL which was not compatible with the generators available at replacement. In a significant number of pts despite a normal IDL performance during the first two years after implantation lead related problems can occur at extended follow up. Regular tests are essential in order to ensure the proper function of the implanted defibrillator and the safety of the pts.
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| 9-2 Incidence, Timing, and Management of ICD Lead Failure. Frauke Gorré, Heidi Rottiers, Winoc Fonteyne MD, Mattias Duytschaever MD, PhD, and Rene Tavernier, MD, PhD, Department of Cardiology, University Hospital Ghent, Belgium. Background. Data on long term ICD lead survival are scanty. Aims. To asses the incidence, timing, presentation and management of failure of the Medtronic 6936/6966 defibrillator leads (both coaxial, non steroid-eluting, polyurethane insulated screw-in leads, only differing in connector type). Methods. Between July 1991 and November 1998, 164 leads (31 Medtronic 6966 and 133 Medtronic 6936) were implanted in 155 patients and followed by ICD interrogation every 3 months (mths). Results. After a mean follow-up of 63±37 mths, 24 leads were abandoned (19 electrical failures after 72±27 mths and 5 infections after 38±25 mths, p< 0,05). In contrast to infections which occur early after implantation, electrical failure probability increases significantly after 80 mths and reaches 30% after 120 mths. Electrical failure presented as oversensing in 14 pts resulting in inappropriate shock delivery in 9 and syncope in one patient due to inappropriate pacing inhibition after hisbundle ablation. A pacing impedance > 2000 Ohms suggesting lead fracture was observed in 3 cases and a high pacing threshold making antitacliycardia pacing impossible in 2 cases. The defect electrode was extracted in 11 cases, capped in 7 and repaired with silicone in 1 case. All infected leads were explanted.
Conclusions: Inappropriate shock delivery is the most frequent presentation of electrical lead dysfunction. In the long-term (>5yrs) reliability of ICD leads is limited.
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| 9-3 VERY LATE FOLLOW-UP OF ACCUFIX 801 ATRIAL LEADS David L. Hayes, MD, David R. Holmes, MD and Linda K. Hyberger. Mayo Clinic, Rochester, MN. Accufix 801 lead follow-up will remain a concern as long as leads are in place. There were 301 Accufix 801 leads that were either implanted or followed at our institution. 120 leads have been removed over the experience. Of the remaining 181 pts, 103 of the pts have expired. No deaths can be attributed to 801 lead failure. Of 78 remaining pts, 43 pts have been lost to follow-up leaving 35 pts who are still actively followed. The most recent fluoroscopic screening offered was 11/5/03. Of the 35 pts screened, there were 2 previously identified fractures with retention wire separation but no definite protrusion from the insulation and unchanged from prior screening. From 1/97 to 11/03, an additional twenty-two 801 leads have been removed from service. Of these, 6 have been abandoned and capped but are still in place and undergo regular surveillance and an additional 16 pts have had the lead extracted. Reasons for extraction were: elective-4, fracture-7, heart transplant-1, infection-2, lead malfunction-1, and removal during tricuspid valve replacement-1. Of the 7 fractured leads; 3 had retention wire separation without insulation protrusion; in 2 pts there were fractures but it could not be determined whether the retention wire was extruding through the insulation; and in 2 pts there was definite extrusion through the insulation. The latest fracture detection occurred at 141 months post implant and 14 months since the last fluoroscopic screening. Summary: Although a relatively small number of our original Accufix population is still being followed with Accufix leads in place (11.6%), fractures are still being identified. Given the potential risk for 801 retention wire fracture even as late as 141 mos post-implant, fluoroscopic surveilance should be continued.
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| 9-4 VENTRICULAR LEAD MODEL CHARACTERISTICS OVER TIME: KAPPA 900® REGISTRY J. Benezet1, W. Landgraf2, K. Kubisch2, A. Cuijpers3, B. Huegl4, S. Henschke5, for the Kappa 900 Registry investigators. Hospital N.S. de Alarcos, Ciudad Real1, Cardiology Clinic, Dortmund2, Bakken Research Center, Maastricht3, Hospital Bad Berka4, KKH Martha-Maria, Halle Dölau5. Purpose: The Medtronic (MDT) Kappa 900 (K900) Pacemaker (PM) Lead Trend diagnostics was used to describe and compare the characteristics of implanted ventricular (V) leads. Methods: Over a 1.8 year period, 95 investigators collected K900 device data from 1595 PM patients suffering from syncope and dizzy spells (54% males, 70±15 years, 66% SND, 80% dual chamber PM, 30% PM dependent). Chronic Pacing Threshold (PT), Auto-Sensitivity (SE) and Impedance (Im) Trend data from 109 different V-leads were retrospectively analyzed, V-leads were grouped into 7 families: 5 MDT endocardial (MDT), 1 MDT epicardial (MDT-Epi) and 1 non-MDT. Results: The table below summarizes the results
Conclusion: K900 Trend Data accurately track properties of leads. Intra-lead pace/sense properties are stable over time.
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| 9-5 LEFT VENTRICULAR LEAD PERFORMANCE IN 120 CONSECUTIVE PATIENTS Andi Eie Albertsen, Jens Cosedis Nielsen, Anders Kirstein Pedersen, Peter Steen Hansen, Henrik Kjærulf Jensen, Peter Thomas Mortensen-Aarhus, DNK OBJECTIVES: Evaluate left ventricular (LV) lead performance and pacemaker related complications in patients treated with Bi-Ventricular pacing. The tip of the LV lead is placed in a coronary sinus tributary. METHODS AND RESULTS: LV lead implant was successful in all of 120 attempted cases (94 male, mean age 62 years, 52% ischaemic heart disease). Implantation and fluoroscope times were reduced in the period from 190 min. to 80 min. and 44 min. to 22 min respectively. Mean follow up was 16.7 months. LV leads thresholds raised during the first month and stabilized afterwards. Reoperation was done in 12 patients because of loss of LV lead capture (6 ptt.), phrenic nerve pacing (3ptt.) and infection (3 ptt.). Another 8 patients had phrenic nerve stimulation at thresholds from 0.75 to 5 V at 0,5 ms duration all treated with pacemaker reprogramming. Two cases of coronary sinus dissection occurred and were treated conservatively. CONCLUSION: Implantation of a pacemaker electrode in a coronary sinus tributary is feasible and safe. Left ventricular lead performance is stable during the first 18 months of follow-up.
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| 9-6 ANOTHER MEASURE OF LEAD RELIABILITY GFO Tvers RG Hauser M Gao J Clark Multi-Center Minneapolis Heart Institute and B.C. Cardiac Registries Vancouver. Purpose Since 1999 the MHIR has independently gathered lead (L) and pulse generator (PG) failure (F) data from 19 centers. All PGs will eventually fail due to EOL so L F should be <PG F; and, as many L models show
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1% F up to 20yrs but others show 
5% F by Syrs, we evaluated L to PG F ratios as a potential measure of L reliability. Method L/PG F ratios were calculated for all MHIR data and for the 3 companies (CO) with 85% of PG reports. Risk ratio (RR) calculations assume random PG Fs and overall L Fs were <5%, and PGs and Ls of each CO were implanted proportionately. Results There were 327 L Fs vs 957 PG Fs, an overall Registry ratio of 34.2%. The combined ratio for the 3 dominant COs was 315/808(40%). Individually the L/PG F ratios were CO A - 50/298(17%); CO B - 92/206(45%); CO C <173/304(57%). L models with 5 or more Fs were: CO A - 1, CO B - 5, CO C - 11. L models on the MHIR Watch List are: CO A - 0; CO B - 2; CO C - 6. The RR for CO A was significantly lower than CO B (0.38–95% CI 0.27–0.53) and CO C (0.29 – 0.22–0.4). There was no sig difference between COs B and C (0.78 – 0.61–1.01). Conclusion There was a substantial difference in need to replace Ls for mechanical and functional F when the 3 highest volume COs were compared. The comparative RRs for L/PG Fs were in agreement with a CO's number of L models with frequent F reports and the number of L models (some recalled some not) on the MHIR Watch List. L design and model selection appear to affect healthcare costs and patient safety. Independent analyses of relative product F rates should encourage COs to provide more thorough premarket testing and earlier recall of high-risk products.
| 10-1 USE OF PHYSIOLOGIC PACING POST CTOPP GFO Tyers M Gao RI Hayden R Leather T Ashton M Kiely British Columbia Cardiac Registry, Vancouver Purpose To determine the effect of CTOPP on mode selection in Western Canada. CTOPP completed enrolment in Feb 96 and by 2000 demonstrated an 18%
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in atrial fibrillation (p<.05) and a 9.4% 
ed from 130 in 97 to 157 pM in 02, giving an 02 total implant rate of 667 PG pM. Over the 6-yr period, the use of AAI±R + VDD±R PG was low and
| 10-2 Indications for pacemakers in the real world: do they follow official guidelines? The Ile de France 2001 regional survey Dr S.Torre*, J.Lacotte, C.Himbert, F.Hidden-Lucet, R.Frank. *CRAMIF, and Unité de Rythmologie, Institut de Cardiologie. G.H. Pitié-Salpêtrière, Paris, France A survey of all 2001 first pacemaker implant were done in Ile de France region. 6414 devices were registered in 49 centers: 329 (5%) in 12 small centers (<50 implantations/year), 2923 (47.5%) in 29 medium centers (50–200/year) and 2902 (47.5%) in large centers (>200/year). 34% of all cases (2176 patients) were drawn in each center for a proportional selection to get a precision of 2.7%. Pacemaker's indications were compared to 2002 ACC/AHA/NASPE guidelines by experts from French Health Care System* and classified according to class 1, 2 or 3 indications. A class 3 indication was found in 8% of overall implantations. They are significantly less frequent in large centers and mainly concern asymptomatic or drug-induced sinus node dysfunctions: 74.5% of class 3 implantations, representing 15.5% of sinus node dysfunction implantations. Others implantations defined as class III were AV blocks (11%), bi or trifascicular blocks (7.5%) and neurocardiogenic syncope (7%). These results are in keeping with those previously reported in Alsace (1999).
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| 10-3 IMPROVED LONG-TERM SURVIVAL IN PACEMAKER PATIENTS OVER 4 DECADES OF PACEMAKER IMPLANTATIONS. Hegbom F1, Gjersdal A1, Brannsten H1,. Sandvik L2, Grendahl H1, Platou ES1. 1Dept. of Cardiology,2 Center of Clinical Research, Ullevål University Hospital, Oslo, Norway. Background: Long-term survival in 2272 (50.5%M/49.5%F) pacemaker patients (PM) implanted from 1961–1999, was compared with age- and sex matched survival from the general population (GP) during the periods 1961–79 (A; n=724) and 1980–99 (B; n=1548). Results: Median age at implantation was 76.0 years. The indication AV-block comprised 60.5%, sick sinus syndrome 28.6%, atrial fibrillation 9.8% and others 1.1%. AV-synchronous pacing was used in 0% in 1961–79, 15% in 1980–89 and 49% in 1991–99. All patients were followed for a minimum of 1 year (mean 16.0±9.1 years) and 83% for a minimum of 5 years. Five-years survival in PM and GP was 52.3% vs. 74.5% in period A and 57.4% vs. 69.7% in period B. The difference in survival PM vs. GP between period A and B was highly significant (p<0.001).
Age, sex and ECG group adjusted 5-years survival for PM in period A and B were 51.2% and 61.2%, and the relative risk of dying in period B vs. A was 0.73 (95% CI 0.63–0,84; p<0.001). Conclusions: Compared to an age-and sex matched general population, PM survival improved over 4 decades of pacemaker implantation.
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| 10-4 INFLUENCE OF THERAPEUTIC IRRADIATION ON THE LATEST GENERATION OF PACEMAKERS C.W. Hurkmans (1), PhD, E. Scheepers (2), B.G.F. Springorum (3), G.S. de Ruiter (3), MD, G.J. Uiterwaal (3) (1) Department of Radiotherapy, Catharina Hospital, Eindhoven, The Netherlands (2) Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands (3) Department of cardiology, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands Introduction: Guidelines for radiotherapy of patients with a pacemaker have been published in 1994 by The American Association of Physicists in Medicine. However, pacemaker technology has evolved rapidly since then. Data on the influence of radiotherapy on modern pacemakers are limited. The objective of our study is to determine the influence of radiotherapy on the latest generation of pacemakers. Materials and Methods: Nineteen pacemakers (Medtronic, Vitatron, Guidant, St. Jude Medical) were irradiated using a 6 megavolt photon beam. The given dose was fractionated up to a cumulative dose of 120 Gy. Frequency, output and sensing have been monitored. Results: 6/19 devices showed atrial and/or ventriculair inhibitions before 5 Gy. Breakdown occurred for 9/19 pacemakers: telemetry failure (at 10 and 120 Gy), premature battery failure (at 120 Gy), loss of output (at 80, 90, 100, 100, 110 and 120 Gy). The sensitivity of the only uni-polar specimen had variations of 100% between fractions. Conclusion: Modern pacemakers are substantially influenced by radiotherapy. However, they do not seem to be much more sensitive than older pacemaker types.
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| 10-5 ELECTROMAGNETIC INTERFERENCE FROM WIRELESS VIDEO-CAPSULE ENDOSCOPY ON IMPLANTABLE PACEMAKERS Dubner Sergio, Dubner Yael, Gallino Sebastian, Spallone Lili, Zagalsky David, Rubio Horacio, Goldin Eran. Clinica Suizo Argentina and Hadasahh Hospital, Israel Objective: This study was designed to evaluate possible interactions between M2A video-capsule (Given Imaging System), a newest system of wireless endoscopy, and implanted pacemakers Methods: The M2A was tested in 100 consecutive patients with an implanted pacemaker (95 on bipolar mode and 70 males). During continuous electrocardiographic recording, 100 tests were carried out at current settings using the TestCap, a functional testing tool for the Given diagnostic system and those with positive results were tested once again. Results: The 100 pacemakers evaluated in the population were as follows: 70 dual-chamber -9 DDD, 56 DDDR, 5 VDD and 30 ventricular-inhibited -12 VVI and 18 VVIR pacemakers; 39 Pacesetter, 32 Medtronic, 15 Guidant, 13 Biotronik and 1 Sorin. In 4, a reproducible undersensing was induced during TestCap operation. Three of them using a dual chamber (Affinity, Trilogy and Logos) and the remaining patient a single chamber (Actros). None of the implanted pacemakers tested were affected by oversensing. According with these results, Pacessetter's devices presented a 5% of undersensing and Biotronik's 15% (Odds ratio 3.3; p= 0.23). Conclusions: Interference from the M2A capsule to the pacemakers was low and not significant to the patient. There were no potentially dangerous pacemaker inhibitions. Our findings showed that the M2A video-capsule caused electromagnetic interference in the form of undersensing in only 4% of the 100 patients tested.
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| 10-6 COMPLICATIONS ARE INFLUENCED BY OPERATOR EXPERIENCE, MORBIDITY AND CHOICE OF PACING SYSTEM Frank Eberhardt, Frank Bode, Hendrik Bonnemeier, Werner Peters, Uwe KH Wiegand, Medical University Luebeck, Cardiology, Luebeck, Germany Purpose: Complication rates of pacing varies between registries and prospective studies. Possible explanations are differences in comorbity and surgical experience. Methods We analyzed records of 1884 VVI, VDD or DDD pacemaker implantations between 1990 and 2001. Operation time (OT) and rate of complications requiring surgical intervention (CR) were analyzed for influence of age, sex, coronary artery disease, myocardial infarction, left ventricular (LV) function, right ventricular (RV) dilatation, sinus node disease, atrial fibrillation and subclavian puncture. Surgical experience (Ex) was graded according to the number of implantations counting each device group independently: ExI 50. Follow-up was 61 ± 33 months. Results: OT was significantly prolonged by the presence of coronary artery disease, inferior myocardial infarction, reduced LV-function and RV-dilatation. Implantation of DDD-pacemakers significantly prolonged OT, particularly in ExI and ExII (left panel). Age >74 years, reduced LV-function, RV-dilatation and DDD implantation were independently predictive for a higher CR. After correction for covariates, a higher CR of DDD was still observed in ExI and ExII, but not in ExIII (right panel). Conclusion: CR is influenced by age as well as left and right ventricular diseases. In ExIII, CR does not substantially differ between DDD, VDD and VVI pacing. Learning curves appear to be steeper in VDD pacing; this might be an argument for use of VDD pacing in AV block.
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| 10-7 The Austrian Pacing registry K. Steinbach, Austrian Heart Foundation, Ludwig Boltzmann institute on Arrhythmia Research Background: Registries are useful to collect epidemilogical data, to observe trends, to compare different departments, to control quality of treatment and to reduce costs. In this paper some examples for evaluation of trends are given. Patients: Data of 73.138* pts (34.942f 38.196m) and 90.435 PM collected between 1.1.80–31.12.2003 from 61 implanting hospitals (99% participation of PM implanting hospitals in Austria) Results: 1) Continuous increase of implantation rate (IR) in pts between 70 and 79y (25 to 47%) and continous decrease of IR in pts between 80 and 89y (58 to 19%) of all 1st implants. 2) No significant change of clinical indication syncope (30 vs 32%) and presyncope (21 vs 24%). Decrease of IR of prophylactic implantation (29 vs 18%) and CHF - (11 vs 6%). 3) IR of AV-block (35 vs 32%), Sick sinus syndrome (SSS) (23 vs 17%). Atriai Fib/Flu (16 vs 20%) in prepacing ECG changed only slightly. IR of Brady/Tachy syndrome (B/T -S) doubled (5 vs 12%). 4) In 2003 91% of. pts with SSS. 82% of pts with AV-block received a physiological PM. 5) In 2003 25% of pts with the indication CHF received a biventricular PM. Summary. 1) Population above 80y seem to be less affected by bradyarrhythmias during the 23y the registry is in operation. 2) No significant change of clinical indications for PMI. 3) New pacing modes explain ihe higher percentage of PMJ in pts with B/T-S especially as preventive measure. 4) The high percentage of physiological pacing as well in SSS as AV-block reflects the opinion of PM-Implanters. that this mode is superior to right vernacular pacing in both indications. 5) Biventricular pacing still is ased oniy in a low number of pts with CHF and is still classified as experimental procedure.
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| 13-1 CONSEQUENCES OF APPROPRIATE AND INAPPROPRIATE THERAPY IN PATIENTS WITH ICD 1Defaye P, 2Delay M, 3Davy JM, 3Pasquié JL, 4Bizeau O, 5Le Marec H, 6Azoui R, 7Leenhardt A, on behalf of OPERA study investigators. 1University Hospital Grenoble, 2University Hospital Toulouse, 3University Hospital Montpellier, 4University Hospital Orléans, 5University Hospital Nantes, 6Guidant France, Rueil-Malmaison, 7University Hospital Lariboisière Paris Introduction: The development of new detection algorithms in the implanted cardioverter defibrillator (ICD) may reduce inappropriate therapy. The aim of the OPERA study was to evaluate the incidence of appropriate therapy and inappropriate therapy in patients implanted with PRIZMTM or VITALITYTM ICD (Guidant). Methods: Among 343 patients (pts) enrolled in OPERA study (295 men, mean age 60.7 ± 14.3 years, mean LVEF 41 ± 16%), 25.6% had a prophylactic ICD indication. NYHA Class II and III were respectively 50% and 10%, 194 pts (56,5%) had coronary artery disease and 27% of pts had a history of atrial arrhythmias. Mean tachycardia detection rate was 164 ± 20 bpm and 17% of devices were programmed with a low tachycardia detection zone at 143 ± 16 bpm. Results: During a 6-month follow-up, 43 (12.5%) pts have received the first appropriate therapy (AT) due to ventricular tachycardia for 79% of them. The first inappropriate therapy (IAT) had occurred in 14 (4%) pts. The delivered therapies and their clinical consequences in terms of hospitalization (H), emergency follow-up (E), drug change (DC), and programining modification (PrM) are reported in the following table:
Conclusion: These preliminary results show a lower percentage of inappropriate therapy than previously reported in the literature. Nevertheless, shocks are delivered in 86% of these IAT, leading to an increase of hospitalizations and emergency follow-ups.
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| 13-2 INCIDENCE OF INAPPROPRIATE DETECTION AND THERAPY OF ARRHYTHMIAS IN PATIENTS WITH PROPHYLACTIC DEFIBRILLATORS. Uma Srivatsa, Bobby Hoppe, Gregory K. Feld, Ulrika Birgersdotter-Green. University of California San Diego, USA Background: Inappropriate ICD therapy due to false detection of arrhythmias is common, and may be reduced by programming Ventricular Arrhythmia Discriminators(VAD) at the time of device implantation. Methods/Results: In 45 patients(age 62±15) with EF 28±8% who had prophylactic implantation of conventional or biventricular ICD, followed prospectively for mean 123±104 days, there were 29 events detected in 15 patients, including ventricular arrhythmia (n=12), sinus tachycardia (n=9), atrial fibrillation(AF)(n=5) and pacemaker mediated tachycardia(n=3). Arrhythmias were correctly identified in 17 of 18 events and incorrectly identified in 9 of 11 events when VAD were programmed ON or OFF respectively (p<0.001). Of the algorithms utilized PR logic (p=0.009), AF(p<0.001), atrial flutter(AFL)(p<0.001) and V>A rate(p=0.016), significantly enhanced appropriate detection, while onset and stability were not effective. For non-ventricular events, diagnosis was appropriate 83.3% and inappropriate 81.8% of the time when VAD were programmed ON or OFF respectively(p =0.009). PR logic(p=0.006), AF(p=0.009), AFL(p=0.009) were the most useful algorithms in differentiating ventricular from non-ventricular events. There were a total 10 shocks delivered in 3 patients during followup. The incidence of inappropriate shocks were more likely if VAD were not programmed at implantation(p<0.001). Conclusion: Programming Ventricular Arrhythmia Discriminators ON at ICD implantation significantly improved detection and classification of arrhythmias, resulting in appropriate therapy. PR logic, AF, AFL and V>A algorithms were the most effective in differentiating ventricular from non-ventricular events.
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| 13-3 Incrementing dual-chamber ICD specificity by interval stability monitoring Robert Bowes, Ralph Mletzko1, Frederic Anselme2,, Wolfgang Schoels3, Marc Delay4, Nicolas Iscolo5, Rémi Nitzsché5, Nicolas Sadoul6, on behalf of the "Slow VT Study" Investigators. Northern General Hospital, Sheffield, UK, 1Herz-Kreislauf Klinik, Bad-Bevensen, Germany, 2Rouen University Hospital, France, 3Heidelberg University, Germany, 4Toulouse University Hospital, France, 5ELA Medical, Le Plessis-Robinson, France, 6Hôpital Brabois, Nancy, France. Inappropriate therapy remains an important limitation of implantable cardioverter defibrillators (ICD). PARAD+ detection algorithm was developed to increase the specificity conferred by PARAD in the detection of atrial fibrillation (AF).
Methods. To compare the performances of the 2 different algorithms, we retrospectively analyzed all spontaneous and sustained episodes of AF and ventricular tachycardia (VT) documented by dual-chamber ICDs (Defender IV and Alto DR, ELA Medical, France) programmed with PARADTM or PARAD+TM at the physicians' discretion. The results were stratified according to tachycardia rates <150 versus Results. During a mean follow-up of 11 ± 3 months, 1019 VT and 315 AF episodes were documented among 338 devices. For slow tachycardias the sensitivity of PARAD vs. PARAD+ was 96% vs. 99% (NS), specificity 80% vs. 93% (p<0.002), positive predictive value (PPV) 94% vs. 91% (NS), and negative predictive value (NPV) 86% vs. 99% (p<0.0001). In the fast VT zone specificity and PPV of PARAD (95% vs. 84% and 100% vs 96%) were higher than those of PARAD+ (NS and p<0,001). Among 23 AF episodes treated in 16 patients, 3 episodes triggered an inappropriate shock in 3 patients, all in the PARAD population. Conclusions. PARAD+ significantly increased the ICD diagnostic specificity and NPV for AF in the slow VT zone without compromising fast VT detection.
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| 13-4 PERFORMANCE OF A SINGLE CHAMBER ICD WITH THE RHYTHM ID ALGORITHM Raffaele Corbisiero, Michael A. Lee, David R. Nabert, Michael C. Giudici James A. Coman, David J. Breiter, Mark J. Schwartz, Yunlong Zhang INTRODUCTION: A new dual chamber supraventricular tachycardia (SVT) algorithm, Rhythm ID, utilizes both conventional "V>A", "AFib Threshold", and "Stability" algorithms, and a vector timing and correlation (VTC) algorithm. In the single chamber configuration, Rhythm ID contains only the VTC component. This study retrospectively analyzed the performance of Rhythm ID to induced and spontaneous rhythms in a single chamber configuration. METHODS: This study was a prospective, multi-center trial and 96 patients were implanted with a dual chamber ICD at 21 U.S. centers. Patients were followed at 1-month and every 3-months post implant. Each episode was analyzed to identify the performance of the Rhythm ID algorithm in the single chamber configuration. RESULTS: The mean age of the patients was 67 ± 11 years (78 male). A total of 359 induced and spontaneous ventricular arrhythmias were analyzed. The algorithm detected all ventricular arrhythmias. A total of 442 SVT episodes were analyzed (145 induced, 297 spontaneous). The SVTs and respective specificities were sinus tachycardia, 71% (n=70), atrial tachycardia, 89% (n=34), atrial flutter, 93% (n=135), atrial fibrillation, 97% (n=199) and non-classified SVT, 100% (n=4). The single chamber Rhythm ID configuration successfully discriminated 403 SVT episodes and achieved a device specificity of 91%. CONCLUSION: The single chamber Rhythm ID algorithm had 100% sensitivity to ventricular arrhythmias and an overall specificity of 91% to SVTs. The algorithm also had very high performance to AF and AFL (97% and 93% respectively). These results demonstrate that the Rhythm ID algorithm in the single chamber configuration achieves clinically acceptable sensitivity and specificity.
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| 13-5 Improving Single Chamber (CD Specificity by Singie A-V Lead A. Curnis1, T. Toselli2, D. Igidbashian3, P. Delise4 on behalf of the Italian ADAMO Registry group - Brescia, Ferrara, Legnago, Conegliano; Italy In single chamber ICDs the main cause for inappropriate shock delivery is improper discrimination of SVT from VT because the lack of atrial sensing. ICDs mod. Belos A+ and DeiKos A+ (Biotronik, D) achieve atria! information through a floating atrial electrode placed on the defoliation single A-V lead mod. Kainox VDD. Improvement of specificity is assured by the SMART algorithm. Aim of the ongoing ADAWO registry is to assess if specificity and sensitivity of SMART algorithm implemented in these devices are comparable to those achieved in dual-chamber ICDs using the same algorithm (93% and 100% respectively). iAt present, 42 pts (32 m, 63±12 y, EF 37±11%, NYHA 1.9±0.6) were enrolled as complying Class I (n=26) or Class II (n=10) ACC/AHA guidelines for single chamber ICD therapy or MADIT II indications (n=6). Pts with chronic AF or SSS were excluded. FU is performed at 2,4,8 and 12 mo. Mean value at implantation were: P-wave 3.1±1.0 mV; R-wave 11.2±3.6 mV; Pacing Threshold 0.5±0.2 V; Effective Shock Energy 17.4±2.4 J and Shock Impedance 70±11 ohm.O Mean total implant and fluoroscopy times were 40±20 and 6.5±5,6 min. respectively. Cumulative FU is 366 mo. During FU at 2, 4, 8 and 12 mo., P-wave amplitude was 2.9±1.4 mV, 3.2±1.0 mV, 2.6±1.2 mV and 2.0±1.4 mV respectively. Memorized IEGMs evidenced: 15 episodes (eps) (n=5) of AF and 54 eps of SVT (n=16) recognized by SMART, 41 eps (n=7) of slow VT/VF interrupted by ATP or shock. In 4 pts inappropriate ATP/shocks were delivered for: T-wave oversensing (n=2), lead displacement (n=1) and atrial undersensing (n=1). Rate of detected atrial signals was 92.7% and 98.9% during AF and SVT respectively. Preliminary data of the ADAMO study are quite positive. The VDD-ICD seems to have high sensitivity and specificity; the system is easy to implant thanks the single-lead approach and it could represent a concrete alternative in most pts in which a single or dual chamber ICD should be implanted.
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| 13-6 IS BI-VENTRICULAR ANTI-TACHYCARDIA PACING MORE EFFECTIVE THAN RIGHT-VENTRICULAR ANTI-TACHYCARDIA PACING? Berthold Stegemann, Johannes Heintze*, Jürgen Vogt*, Bart Gerritse, Sandra Jacobs, Bart Gerritse: Bakken Research Center, Maastricht, Netherlands; *Herz- und Diabeleszentrum NRW, Bad Oeynhausen, Germany Aim: Combination devices such as the InSync ICD (Medtronic Model 7272) offer independent programmability of CRT and anti-tachycardia pacing (ATP). The majority of VT originate from the left ventricle and ATP efficacy should thus be higher for bi-ventricular (BV)-ATP. Methods: The InSync ICD study enrolled 89 pts in NYHA II-IV, LVEF<35% and QRS width >130 msec. We retrospectively analyzed VT episodes from the device with true spontaneous VT onset, delivery of at least one ATP therapy and known ATP efficacy. First-therapy ATP efficacy was analysed using a logistic GEE model. Results: 26 pts experienced 610 VT episodes. 569 VT episodes in 23 pts fulfilled all criteria above. First ATP therapy was successful in 494 episodes (86.6%). BV-ATP was programmed in 10 pts and to RV-ATP in 16 pts; 3 pts had both modes programmed at different times. Logistic GEE model efficacy estimates of first-therapy efficacy were 88.7% (CI:80.7–93.6%) for BV-ATP and 68.3% (CI:49.7–82.4%) for RV-ATP. The difference is significant (p=0.0006). Only VT cycle length, presence of ACE-inhibitors and statins significantly added to the model. Controlling for this covariates first-therapy efficacy were 91.7% (CI:83.5–96.0%) for BV-ATP and 77.5% (CI:55.2–90.6%) for RV-ATP (p=0.01). Conclusions: ATP therapy is effective in patients with heart failure. BV-ATP is significantly more effective, even after correction for VT cycle length and cardiac medication, This clinical effect needs to be confirmed prospectively.
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| 14-1 PATIENTS UNDERGOING CARDIOVERTER-DEFIBRILLATOR TREATMENT: HIGHEST RISK OF CARDIAC DEATH HAS BEEN OBSERVED DURING THE FIRST YEAR AFTER IMPLANTATION. A LATIN - AMERICAN COOPERATIVE REGISTRY: THE ICD-LABOR R Pesce, JC Pachon Mateos, E Valero, R Garillo, C Conejeros Kindell, H Sgarlatta, S Dubner, JL Montenegro, S González, on behalf of the ICD-LABOR investigators. Fleni, I Dante Pazzanese, Universidad del Salvador, H Barros Luco, S Allende, S Suizo, CASMU, I Cardiología. Introduction: The ICD-LABOR registry includes 7 Latin-American countries, 91 medical centres, 125 investigators and 632 patients (pts) distributed as: 247 (39%) coronary artery disease (CAD), 171 (27%) Chagas' disease (ChD), 110 (17.5%) dilated cardiomyopathy (DCM), and 104 (16.5%) as Miscellaneous(this last group were not analyzed in the present paper). Methods: Of the remaining 528 pts. age, gender, pacing and defibrillation threshold, ejection fraction (EF), mode of outcome and follow-up period were analyzed. Results: During the follow-up period of 24 ±22 months (range 1–168 months), 69 cardiac deaths were registered and they were divided in two areas: early death (ED)(within the first year post implantation), and late death (LD)(beyond the first year). In the CAD Group, 24 EDs (EF 27.5%±12) and 13 LDs (EF 37.4%±12) were reported, p<0.0288. In the cardiomyopathy (CM) Group, (DCM+ChD), 16 EDs (EF 26.8% ± 6.9), and 16 LDs (EF 25%±4.8)were reported p=NS. Looking exclusively of EDs: non-sudden cardiac death was predominant in CAD Group (17 of 24)versus CM Group (2 of 16) p<0.0039 Conclusion: 1. EF had predictive value of risk of cardiac mortality in the first year of follow-up only in CAD pts., 2.- Among the data analyzed there were no predictors of mortality in CM Group, 3.- Among ED patients, non sudden cardiac death was statistically higher in CAD pts than in CM pts.
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| 14-2 Incidence and outcome of primarily untreated slow ventricular tachycardia in ICD patients. E. Adornato1, W. Schoels2, F. Anselme3, A. Pangallo1, V. Pennisi1, R. Mletzko4, M. Delay5, N. Iscolo6, N. Sadoul6, on behalf of the Slow VT Study group. 1A.O. Bianchi-Melacrino-Morelli, Reggio Calabria, Italy; 2Universitatskliniken, Heidelberg, Germany; 3University Hospitals, Rouen; 4Herz-Kreislauf-Klinik, Bad-Bevensen, Germany; 5Toulouse and 7Nancy University Hospitals, France; 6Ela Medical, Le Plessis-Robinson, France. Incidence and clinical tolerance of slow ventricular tachycardia (VT) have not been fully studied in general ICD population. The "Slow VT Study" was a prospective study, in which therapies in the slow VT detection zone (101–148 bpm) were randomised on or off. We report the prevalence and the cilinical outcome of slow VT in the group of patients (pts) with no therapy in the slow VT detection zone. Methods. Pts were eligible in the study if they had class I indication for dual chamber ICD and no prior history of symptomatic slow VT. All pts received Defender IV or Alto DR ICDs (ELA Medical, France). One hundred and eighty eight pts were enrolled (168 males, 64±10 years, LVEF 0.38±0.15). Slow tachycardia episodes (eps) were recorded over a 1 year follow-up period. Results. VT was identified in 192/3058 recorded eps of slow tachycardia in 51 pts. Among these eps, 153 (80%) in 49 pts terminated spontaneously (sp.) or decelerated below 101 bpm (duration: 7,6±22,5 min), 12 (6%) accelerated above 148 bpm and were subsequently treated, 27 (14%) were detected and treated after slow VT therapies activated by the physician. This activation was required because of re-hospitalisation for heart failure (n=3 pts), or occurrence of palpitations or dizziness (n=7 pts). Pts with slow & fast VT (31) presented a greater number of slow VT as compared to pts with slow VT only (18) (Wilcoxon test). Conclusions. More than 25% of the study population presented with unexpected slow VTs. Activation of slow VT therapies was required in 5% of the slow VT pts population during FU.
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| 14-3 DFT AND HEART FAILURE IN ICD PATIENTS WITH SINGLE OR DUAL COIL LEADS Xiaoyi Min, Ph.D. Xiaozheng Zhang, MD, Jennifer Studt, St. Jude Medical Sylmar, CA, William H. Kou, MD, Ann Arbor VA Hospital, Ann Arbor, MI, Thomas Deering, MD, Piedmont Hospital, Atlanta, GA, Steven Keim, MD, Lakeland Regional, Lakeland, FL, Larry Rosenthal, MD, Univ. of Massachusetts, Worcester, MA Purpose: It was reported that high DFT may be associated with worsened NYHA, low EF and LV dilation. However, it is unclear whether the outcomes were specific to shocking electrode systems. We evaluated lead system on relationship of DFTs to NYHA and EF. Methods: The analysis included 302 ICD patients (pts) (age 66±12 years, 83% male), 234 had dual coil and 68 had single coil leads. The correlations of DFTs with NYHA and EF were tested using Spearman Correlation. DFTs were further compared between pts with NYHA I&II and NYHA III&IV, and pts with EF<35% and EF>35%. Results: DFT (J) correlated inversely with NYHA in pooled data (p=0.03). However, the correlation trend was only consistent with pts had dual coil leads (r=-0.2, p=0.001). Further analysis showed dual coil leads pts with NYHA III&IV had lower DFTs compared to NYHA I&II (14±6J vs. 16±5J, p=0.02); pts with EF>35% had higher DFTs compared to EF<35% (16.7±5.7J vs. 15.3 ± 5.1 J, NS). The reversed results were seen in pts with single coil leads (NS). Conclusion: The trend in DFT as NYHA class worsened is lead system dependent. DFT trend in single coil pts is consistent with early published data. However, heart failure progressed fluid overload in the connective tissue may increase current flow from SVC coil to posterior LV free wall, thereby reducing DFT with dual coil lead system.
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| 14-4 CAN THE IMPLANTABLE CARDIOVERTER/DEFIBRILLATOR AVOID ARRHYTHMOGENIC SYNCOPE? Przibille, Oliver; Himmrich, Ewald; Andreas, Klaus; Nebeling, Dirk; Theis, Cathrin; II. Medical Clinic, University Hospital Mainz, Germany Aim: Analysis of syncopes in pts. with ICD and time frame during which the first syncope occured. Are there any predictive factors? Method: We retrospectively analyzed 165 pts. with appropriate ICD therapies (97% shock, 3% ATP only) and a follow-up > 24 months (67±29). Patient cohort: m 132, f 33; age 59.6±12 yrs; CHD 58%, idiopathic cardiomyopathy 24.8%, other cardiac disease 27.2%. Results: 82/165 pts. (49.7%) had syncopes due to ventricular tachyarrhythmias treated by the ICD ; 42 pts. had > 1 syncope. Pts. with and without syncope did not differ in age, sex, underlying heart disease, LV ejection fraction (41±15 vs. 42.7±17%): NYHA classification or syncopal episodes before ICD implantation. There was no correlation between incidence of syncope and LV-EF or number of ICD therapies. Tachyarrhythmias causing syncope were significantly faster (263±47 vs. 206±43 bpm). The mean time interval between ICD implantation and first syncope was 29.1±25 months. In only 40.2% of the pts. it occurred during the first 6 months after implantation and in 52.4% during the first year. The syncope-free survival of patients is shown in the following table:
Conclusion: Half of the patients with appropriate ICD therapies suffer from arrhythmogenic syncope. The individual risk cannot be predicted and the syncope-free interval after implantation shows an enormous variation. Since the ICD cannot prevent arrhythmogenic syncope, this risk must be considered when giving pts. advice about activities of daily life (driving, swimming, etc.)
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| 14-5 VT AND ATP THERAPY IN ICD PATIENTS WITH CORONARY ARTERY DISEASE AND LV DYSFUNCTION 1Thomas Deering, MD, 2Jennifer Studt, 2James Tyler, 3Bill Kou, MD, 4Steven Keim, MD, 5Larry Rosenthal, MD, 6Alaa Shalaby, MD, 2Bruce Meredith, 1Piedmont Hospital, Atlanta, GA, 2St. Jude Medical CRMD, Sylmar, CA, 3Ann Arbor VA Hospital, Ann Arbor, MI, 4Lakeland Regional, Lakeland, FL, 5University of Massachusetts, Worcester, MA, 6Pittsburgh VA Medical Center, Pittsburgh, PA Purpose: Although MADIT II demonstrated that implantable cardioverter defibrillators (ICDs) improve survival in patients with a left ventricular ejection fraction (LVEF) <30% and a previous MI, the incidence of VT and ATP therapy in this population is unknown. Methods: Seventy-seven patients with a history of CAD and LVEF <30% (mean 22±6%) were identified from 3 multi-center studies followed for at least 6 months after implantation. The average age was 66.5±9.7 years; 73.9% had experienced NYHA class II-IV congestive heart failure (CHF) 88.3% were male. Results: Nineteen (24.7%) patients had 360 episodes of appropriately diagnosed VT (mean cycle length of 394±48.1 ms). Sixty-nine (19.2%) of these episodes were successfully reversed by ATP. The remaining 80.8% episodes either terminated spontaneously or were terminated by shock therapy. Conclusion: VT is a relatively common arrhythmia occurring in patients with an ischemic cardiomyopathy and LVEF < 30% who undergo ICD implantation for primary prophylaxis. Enabling ATP, if it is available in the ICD, may reduce the morbidity of symptoms secondary to painful shock therapy.
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| 14-6 FREQUENCY OF ADEQUATE ICD INTERVENTIONS IN PATIENTS WITH HYPERTROPHIC CARDIOMYOPATHY AFTER ICD IMPLANTATION FOR PRIMARY PREVENTION H. Buschler, J. Vogt, B. Lamp, J. Heintze, D. Horstkotte, L. Faber. Department of Cardiology, Heart Center North Rhine-Westphalia, Ruhr University of Bochum, Bad Oeynhausen, Germany
For patients (pts) with hypertrophic cardiomyopathy (HCM) a number of risk factors concerning sudden cardiac death (SCD) have been proposed (syncope, family history of SCD, non sustained ventricular tachycardia (nsVT) on Holter, abnormal blood pressure response during exercise, LV wall hypertrophy >30 mm). Prophylactic ICD implantation has been recommended, if two or more risk factors are present. In our cohort of >800 pts with HCM we identified 20 pts, in whom we implanted an ICD as primary prophylaxis of SCD according to these criteria. The cohort consisted of 4 women, 16 men, mean age 40 ± 14.2 years (15–65 y), 12 PTs with HOCM, 8 Pts with HNCM, 1 pt with additional CAD after PTCA, NYHA class 2.0 ± 0.8. The majority of pts received conventional beta-blocker, 1 p had Amiodaron, 2 pts had Verapamil. NsVT was present in 15 pts, 11 had syncope, 8 had a family history of SCD. 17 pts. Underwent an electrophysiologic study in order to exclude supraventricular arrhythmias, 11 of these (65%) had inducible VT/VF. All pts received a dual chamber ICD. During a mean follow up of 13.5 (3 Fifteen percent of high risk pts with HCM after ICD implantation for primary prevention of SCD received adequate therapies because of VF or fast VT during a FU of only 13 m. The incidence of malignant arrhythmias in this cohort is high and ICD implantation should be strongly considered.
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8) months (270 patient months) 4 adequate ICD interventions in 3 pts were documented: 1 p with 2 episodes of VF, 2 p with sustained VT. Inadequate ICD interventions because of sinus tachycardia and T wave oversensing occurred in 1 p.
| 17P-1 IS A PROVOCABLE BRUGADA SIGN IN ARRHYTHMOGENIC RIGHT VENTRICULAR DYSPLASIA-CARDIOMYOPATHY A MARKER OF INCREASED ARRHYTHMOGENIC RISK? Peters S, Trümmel M, Koehler B - Cardiology, Quedlinburg, Germany In 10–15% a Brugada-type ECG can be induced by drug challenge in arrhythmogenic right ventricular dysplasia_cardiomyopathy (ARVD/C). In typical Brugada syndrome an increased arrhythmogenic risk is present in cases with documented arrhythmias and aborted sudden cardiac death (recurrence rate 50%) and in cases of syncopes (recurrence rate 15%). The question is whether Brugada sign in ECG represents a marker of increased arrhythmogenic risk in ARVD/C, too. Systematic ajmaline testing (1mg/kg) in 82 patients with ARVD/C according to ISFC/ESC criteria could induce Brugada sign in 14 cases (17%) - 3 males und 11 females. Syncopes were present in 5 cases (36%); one female patient had aborted sudden cardiac death. During EP study only in one patient monomorphic ventricular tachycardia could be induced. 4 patients were treated by ICD implantation. Conclusions: A provocable Brugada sign is associated with moderately to highly increased risk of clinical events in nearly half of all patients and represents a strong marker of increased arrhythmogenic risk also in patients with ARVD/C.
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| 17P-2 A CASE OF A SHORT COUPLED VARIANT OF TORSADE DE POINTES WITH A PROMINENT J WAVE Takeuchi T, Nakagawa N, Tanabe Y, Takahashi F, Sato M, Sato N, Kawamura Y, Hasebe N, Kikuchi K - 1st Dept. Internal Medecine, Asahikawa Medical College, Japan We present a case with a short coupled variant of Torsade de pointes (Tdp), whose recurrent episodes of ventricular fibrillation (VF) were suppressed by the combination therapy of oral verapamil and mexiletine, and in which a prominent J wave was diminished by the verapamil. The patient's frequent VF attacks were triggered by short-coupled premature ventricular contractions (PVCs) with a right bundle branch block morphology and left axis deviation. In the electrophysiologic studies, VF was not induced with up to three consecutive extrastimuli or burst stimulation from the right ventricular apex or right outflow tract, either in the baseline state or during the infusion of isoproterenol. Further, no ST segment abnormalities were induced by autonomic receptor stimulation or blockade, such as with methoxamine, edrophonium or procainamide. However, an intravenous administration of atropine resulted in VF triggered by a short coupled PVC, which lead to an electrical storm. Finally, the VF attack was completely suppressed by deep sedation followed by the combination therapy of oral verapamil and mexiletine.? Interestingly, with oral mexiletine therapy, prominent J waves were still observed in leads V3-V6 in the patient, and his daughter also exhibited a similar pattern of early repolarization or J waves in the precordial leads. On the other hand, after adding oral verapamil, the prominent J waves on the electrocardiogram and VF attacks almost completely disappeared. These results suggest new evidence that (1) abnormal verapmil and mexiletine sensitive tissues may contribute to the short coupled variant of TdP, and (2) verapamil is effective for this syndrome probably caused not only by suppressing the triggered activity, but also by surpressing the transient outward current and reducing the transmural voltage gradient responsible for the J waves in some particular cases.
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| 17P-3 ATRIAL FIBRILLATION IN PATIENTS WITH WOLFF-PARKINSON-WHITE SYNDROME R. Batalov, S. Popov, I. Antonchenko, V.Aleev Research Institute of Cardiology, Tomsk, Russia Occurrence of atrial fibrillation(AF) in patients with Wolff-Parkinson-White (WPW) syndrome, burdens clinical course especially at patients with demonstrating forms of WPW. At the same time presence of additional anatomic junction between atria and ventricle results itself in development of AF, that is especially not typical of young patients of the general population, without organic heart pathology. The purpose of the research: Comparison of duration of disease and development of atrial fibrillation in patients with WPW syndrome. Material and methods. 220 patients with WPW syndrome were included into research. From them: with manifesting - 118, concealed - 76 and latent - 26. All patients underwent Electrophysiological study with the subsequent successful radiofrequency ablation of additional atrioventricular junction (AVJ) (Table 1).
Mean age of patients 34,4±16,4 years. Duration of arrhythmological anamnesis in group of patients without AF averaged as 10,3±4,9 years, and in patients with AF 15,1±6,7 (p = 0,003). See figure. Localization of additional AVJ in 139 (63,2%) was left side and in 81 (36,8%) patients - right side. Localization of additional AVJ in patients of two groups is represented in Table 2.
Conclusions: AF occurrence depends on duration of arrhytmological anamnesis. The longer patients have reciprocal tachycardia attacks the higher the risk of AF occurrence. AF occurrence also depends on localization of additional AVJ. Left posterioseptal a position is the most frequently occured. Localization of additional AVJ can serve as a preliminary marker of probable development of atrial fibrillation paroxysms, that it is necessary to take into account during diagnostic pacing and prospective patients' follow-up after ablation.
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| 17P-4 DOES ATRIAL FIBRILLATION CONFER HYPERCOAGULABLE STATE? Beata Wozakowska- KapBon-1), Grzegorz Opolski2), Marianna Janion1) 1.) Dept. of Cardiology Regional District Hospital, Kielce, Poland 2.) Dept. of Internal Medicine and Cardiology Medical University of Warsaw, Poland Atrial fibrillation (AF) is strongly associated with thromboembolic complications, although the mechanism for the increased risk has not been fully explained. It is not clear whether this hypercoagulable state is attributable to the underlying disease or AF alone. The aim of this study was to determine whether AF induce modifications to the coagulation system in patients with heart failure and impaired left ventricle. Methods: Hemostatic markers for abnormalities of hypercoagulability were evaluated in peripheral blood in 17 patients with permanent AF (mean AF duration 6 months) and decreased left ventricular ejection fraction (EF<40%) and in 10 patients with sinus rhythm, matched with age, sex, concomitant diseases and echocardiographic findings. Plasma levels of hemoglobin, hematocrit, fibrinogen, D-dimer and platelet aggregation in respose to ADP were measured. None of patients were receiving anticoagulation therapy before and they did not have a history of embolisation. Results: When compared with the sinus rhythm group (n=10), the AF patients had significantly higher mean hematocrit, hemoglobin, fibrinogen and D-dimer plasma levels: 46,4±4,0% vs 44,2±3,5%; 15,4±1,7 g/dl vs 14,3±1,4 g/dl; 3,78±0,6 g/l vs 2,60±0,5 g/l; 480,8±206,4 ng/ml vs 367,6±192,4 ng/ml, AF vs sinus rhythm respectively;(p<0,05, p<0,05, p=0,05 and p<0,05). In patients with AF 11 out of 17 had hyperaggregable platelets in response to ADP while none had of sinus rhythm group. These results indicate that AF itself enhances platelet aggregation and coagulation. Conclusion: AF itself confer hypercoagulability state regardless of the risk factors of the subjects and the presence of cardiovascular disease and impaired left ventricle. Futher prospective studies are needed to evaluate whether measurement of hemostatic factors will identify patients with AF who are at increased risk for thromboembolic complications and need more intensive antithrombotic therapy.
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| 17P-5 DOES ANTIARRHYTHMIC TREATMENT WITH AMIODARONE ENHANCE QUALITY OF LIFE OF ATRIAL FIBRILLATION PATIENTS REVERTED TO SINUS RHYTHM? Beata Wozakowska-Kaplon1), Grzegorz Opolski2), Marianna Janion1) 1.) Dept. of Cardiology Regional District Hospital, Kielce, Poland 2.) Dept. of Internal Medicine and Cardiology Medical University of Warsaw, Poland Background. Although the assessement of survival is vital to evaluating the efficacy of therapeutic strategies, quality of life (QoL) measurement is important for understanding how these strategies impact the daily lives of patients. Atrial fibrillation (AF) may comprise QoL by several mechanisms: haemodynamic consequences of AF, association with thromboembolism or management inconveniece. The aim of the study was to evaluate QoL in patients with persistent AF before and 6 months after sinus rhythm restoration. Methods: The study group comprised of 20 patients (56,7±6,2 years) with persistent AF (6,7±6,5 months) and 10 control subjects matched with sex, age and concomitant diseases with normal sinus rhythm. The study group underwent cardioversion from AF and was maintaining sinus rhythm following 6 months period with amiodaron administered as a prophylactic treatment. The QoL was measured using generic SF-36 scale (with a physical component summary, PCS, and a mental component summary, MCS) and Brignole AF Symptom Checklist (SCL), at baseline (before treatment) and 6 months after sinus rhythm restoration. Results Patients with AF had substantially impaired QoL compared with control subjects: 37±17 vs 69±21 (p<0,05);44±12 vs 72±23 (p<0,05); PCS and MCS consecutively. Sinus rhythm restoration and treatment with amiodarone appeared to improve QoL in study group: 37±17 vs 44±11 (p<0,05); 44±12 vs 49±11 (p=0,04) and 26±5 vs 21±4 (p<0,05); PCS, MCS and SCL at baseline and over the follow-up period respectively. Conclusion These findings demonstrate health dysfunction for pts with AF. A successful cardioversion and maintenace of sinus rhythm with amiodarone is associated with higher QoL in pts with persistent AF.
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| 17P-6 OCCURRENCE AND TYPE OF REPERFUSION ARRHYTHMIAS IN ACUTE MYOCARDIAL INFARCTION IS INFARCT-RELATED ARTERY DEPENDENT - A HOLTER SUB-STUDY OF THE ASIA PACIFIC MYOCARDIAL INFARCTION TRIAL (APAMIT) Aaron Wong, Li-Fern Hsu, Wee-Siong Teo, Koon-Hou Mak, Ruth Kam, Charles Chan, Tian-Hai Koh, Yean-Leng Lim National Heart Centre, Singapore; Background: Controversy exists as to whether arrhythmias after reperfusion of infarct-related artery (IRA) are secondary to reperfusion alone. This study aimed to determine the incidence and type of arrhythmias related to reperfusion in AMI patients undergoing primary angioplasty (PA). Methods: Holter recordings were obtained from patients with AMI treated with thrombolysis or PA. All patients had coronary angiography, to assess TIMI flow grade, and PA performed if required. Cardiac rhythm was recorded for 24 hours from the time of arrival in cardiac laboratory. The types and occurrence of arrhythmias in patients with initially occluded IRA (TIMI 0 or 1) and successful PA (acute reperfusion group) was compared to a control group, who had patent IRA (TIMI 2 or 3) on initial coronary angiography and remained patent, with or without PA. Results: Fifty-nine eligible Holter recordings (acute reperfusion=23 and control=36) were obtained. The baseline demographics were similar with 83% male and a mean age of 56 years. The IRA was LAD in 44% of patients. Accelerated idioventricular rhythm (AIVR) and sinus bradycardia (SB) were significantly more common in patients with acute reperfusion (65% vs. 39%, p=0.049 and 3% vs. 30%, p=0.004, respectively). AIVR were founded to be more common in acute reperfusion of LAD (67% vs. 28%, p=0.05), whilst SB occurred more frequently in RCA (46% vs. 6%, p=0.02). The occurrence of other arrhythmias was not different between the 2 groups. Conclusions: Acute reperfusion in patients with occluded IRA resulted in significant higher incidence of arrhythmias, suggesting that reperfusion of occluded IRA does induce arrhythmias, and occurrence of specific arrhythmias appeared to be IRA-dependent.
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| 17P-7 QT DISPERSION IN HYPERTENSIVE SUBJECTS WITH "NON-DIPPING" 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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| 17P-8 EFFICACY OF ANTIARRHYTHMIC AGENTS TO PREVENT PAROXYSMAL ATRIAL FIBRILLATION 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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| 17P-9 AUTONOMIC MODULATION FOLLOWING ELECTRICAL CARDIOVERSION OF ATRIAL FIBRILLATION: RELATION WITH EARLY RECURRENCE. Emanuele Bertaglia, Franco Zoppo, Carlo Bonanno*, Nicola Pellizzari, Nicoletta Frigato, Pietro Pascotto. From the Departments of Cardiology, Ospedale Civile, Mirano; *Ospedale S. Bortolo, Vicenza, Italy. Aim. Aims of this study were to to correlate early atrial fibrillation (AF) relapses with heart rate variability (HRV) parameters immediately recorded after electrical cardioversion (EC) of persistent AF. Methods. We performed the spectral analysis of short-term HRV 30 min after EC in 25 patients with persistent AF. Results. The numbers of patients who maintained sinus rhythm at 48 h, seven days, and 30 days were 22, 16, and 14 respectively. A very low low frequency/high frequency ratio [0.93 (0.08) vs 1.89 (1.30); p=0.003] significantly identified patients with AF recurrence at 48 h in comparison to patients without AF recurrence. On the contrary, HRV parameters did not identify patients with AF recurrence at seven or 30 days. Conclusion. AF relapsed within the first 48 h more frequently in patients who presented a predominant vagal tone immediately after the restoration of sinus rhythm.
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| 17P-10 RELATIONSHIP BETWEEN HRT PARAMETERS AFTER ECTOPIC BEATS AND HEART RATE VARIABILITY IN PATIENTS WITH CHD AND DIFFERENT TYPES OF VENTRICULAR ARRHYTHMIAS. Szydlo K., Trusz-Gluza M., Orszulak W., Wita K., Filipecki A., Urbanczyk D. Ist Dept. of Cardiology, Silesian Medical Academy, Katowice, Poland. The purpose of the study was to find out if any links between heart rate turbulence (HRT) and heart rate variability (HRV) might be observed in patients with previous MI and different types of ventricular arrhythmias, when premature atrial (PAC) and ventricular (PVC) contractions were used for HRT calculation. The study population consisted of 80 pts with previous MI with episodes of non-sustained VT (nsVT), sustained VT (sVT) or documented ventricular fibrillation (VF). Patients were divided into two groups. Forty pts without sVT or VF (No VT/VF) (25males, 58±7 yrs, EF-45±7%) and 40 pts with sVT or VF (VT/VF) who underwent ICD implantation (36 males, 57±11 yrs, EF-42±11%). HRT values (TO and TS-turbulence onset and slope) were calculated from the one strip both after PVC and PAC for each patient. HRV parameters (SDRR, rMSSD, LF, HF) were used. Results: values of correlation coefficients are given (for TS): PVC:for SDRR (ms) and RMSSD (ms) No VT/VF: 0.67* and 0.54* VT/VF: 0.52*, 0.41** PAC:for SDRR (ms) and RMSSD (ms) No VT/VF: 0.44* and 0.34** VT/VF: 0.39* and 0.42** *-p=0.01, **-p=0.05 Similar results were obtained for LF and HF. Strong relationships between TS and HRV were observed, especially for PVC. Such a correlations were not present for TO. Moreover, the HRV parameters were remarkable higher in No VT/VF. Conclusion: HRV values differentiated pts with benign and malignant arrhythmias. Strong relationship between these parameters and turbulence slope was found. This may indicate that similar mechanisms are involved in generation of both HRT and HRV.
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| 17P-11 CLINICAL USEFULNESS OF BEPRIDIL IN THE TREATMENT OF ATRIAL FLUTTER Yasuda M, Nakazato Y, Sasaki A, Yamashita H, Kawano Y, Iida Y, Nakazato K, Tokano T, Mineda Y, Sumiyoshi M, Nakata Y, Daida H. Department of Cardiology, Juntendo University School of Medicine, Tokyo and Juntendo Izu-Nagaoka Hospital, Shizuoka, Japan The effects of oral bepridil (Bpd) for atrial flutter (AFL) refractory to class 1 antiarrhythmic drugs were evaluated. Bpd was administered to 50 patients (39 male, mean 63 years old), 30 of which had paroxysmal AFL and 20 of which had persistent AFL. In 20 of 30 patients (66.7%) with paroxysmal AFL, Bpd effectively prevented attacks during an average follow-up period of 18 months. In 16 of 20 patients with persistent AFL (76.2%), AFL was converted into sinus rhythm within an average time of 1.7 months following administration of Bpd. In addition, 15 of those 16 patients have been maintained in sinus rhythm during an average follow-up period of 19 months. ECG revealed prolongation of QT(U) interval from 0.38±0.05 to 0.42±0.05 sec (p
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| 17P-12 ANTI-TACHYCARDIA THERAPY ALTERED MYOCARDIAC GLUCOSE METABOLISM OF THE PATIENTS WITH TACHYCARDIA-INDUCED CARDIOMYOPATHY K Matsumoto, N Takahashi, S Sumita, T Ishikawa, K Matsushita, T Kobayashi, N Kawasaki, Y Yamakawa, K Uchino, T Inoue, K Kimura, S Umemura We assessed left ventricle(LV) function and myocardial glucose metabolism of the patients with tachycardia-induced cardiomyopathy(TC) by using 18F-flurodeoxyglucose(FDG) PET. Forty-two patients with heart disease, consisting of 7 patients with TC(61.6±19.0yrs, LVEF is 41.3±18.4%) and 35 with Ischemic heart disease (IHD)(63.1±10.8yrs, LVEF is 49.9±13.6%). TC was determined as impairment of left ventricular function secondary to chronic or very frequent arrhythmia during more than 10% of the day. IHD patients were revealed significant stenosis by coronary angiography. All of the patients underwent FDG PET and echo-cardiography, and all of the patients with TC underwent FDG PET and echo-cardiography before and 6 months after the anti-tachycardia therapy. As anti-tachycardia therapy, 6 patients were performed radiofreuency catertel ablation and 1 patient was medically treated. We assesse myocardial glucose metabolism semi-quantitatively by using % dose uptake of 60kg of BW (% dose uptake). After anti-tachycardial therapy, LVEF were significantly improved(41.3±18.4% vs 54.3±13.6%, P=0.01), and % dose uptake also significantly improved (1.29±0.35 vs 1.52±0.37,P=0.05). Patients with IHD showed higher value of % dose uptake than TC(2.98±0.82 vs 1.29±0.35, P Evaluating in semi-quntitative analysis of FDG PET, anti-tachycardia therapy altered myocardiac glucose metabolism of the patients with tachycardia-induced cardiomyopathy.
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| 17P-13 INTRAMYOCARDIAL VEGF GENE ADMINISTRATION COMBINED WITH DIFFERENT METHODS OF REVASCULARIZATION IN IHD PATIENTS Eremeeva M., Bokeria L., Golukhova E., Polyakova E., Lukashkin M. For patients with severe myocardial ischemia such interventions as angioplasty or bypass surgery may be required. But a certain group of patients may have no further percutaneous or surgical options. Intramuscular transfection of genes encoding angiogenic cytokines may be alternative strategy for treatment of such group of patients. In our investigation, 16 patients undergoing surgical revascularization received plasmid gene hVEGF 165, injected directly into the heart muscle supplied by coronary artery with distal obstruction. Inclusion criteria: IHD, stable angina III–IV CCS, a significant perfusion defect detected by SPECT and PET. Eligible patients underwent elective CABG, combination CABG + TMLR or TMRL only, but had at least one ischemic territory that was not bypassed due to an unsuitable coronary anatomy. Follow-up was performed in 3 months. Treadmill test and myocardial perfusion imaging were performed before treatment and at 120 days after treatment. All patients reported significant angina relief and improvement quality of life. Patients increased their treadmill exercise times by a mean of 198,8 seconds at the 120-day treadmill compared with baseline testing. Regional wall motion and perfusion were improved, including ungrafted areas with only hVEGF 165 injection.
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| 17P-14 HEART RATE VARIABILITY, INFANTS AND PAROXYSMAL ATRIOVENTRICULAR BLOCK G.Grutter, M.S.Silvetti, A.De Santis, F.Drago Bambino Gesù Hospital, Rome, Italy Purpose of this study is the analysis of the Heart Rate Variability (HRV) in paediatric patients affected by paroxysmal atrio-ventricular block (PAVB). METHODS: PAVB was diagnosed in 9 patients (6 females and 3 males), aged 13+/–4,7 (range 7–21 years)at Holter monitoring. HRV was analysed during 24 hours, at day and night hours, 1 hour, 30 minutes and 1 minute before the longest asystolic pause and were compared with controls. RESULTS: During PAVB, asystolic pauses lasted longer in female patients (3,7+/–0,6 sec) than in males (2,3+/–0,5) (p=000.1). SDNNi and rMSSD values were significantly higher in all patients than in controls; in female patients SDNN was higher than controls (p=000.1). The analysis of HRV before the longest pause showed in all patients a significant reduction of SDNN and SDANN (to zero) and in females also a significant reduction of pNN50 values. CONCLUSIONS: These data seem to confirm the hypothesis of an unbalance of sympatho-vagal modulation on sinus and AV node, as the cause of PAVB.
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| 17P-15 BEHAVIOR OF NONINVASIVE PARAMETERS OF REPOLARISATION IN MYOCARDIAL ISCHEMIA Michal Wasniewski, Romuald Ochotny, Maciej Lesiak, Przemyslaw Mitkowski, Andrzej Cieslinski Methodological problems related to QTd calculation during myocardial ischemia diminishes its clinical utility. Tpeak-end time can represent transmural dispersion of repolarisation. Little is known about its behavior during ischemia. Standard deviation of QT interval (QT-sd) is a statistical control of QT interval variability. Purpose: Comparison of these parameters during ischemia induced by PCI balloon inflation. Methods: 81 patients scheduled for elective PCI (31 LAD, 27 CX and 23 RCA). ECG was recorded (200mm/sec; 40mm/mV) twice: before procedure and in 60th second of first balloon inflation. Results: All parameters increased significantly during ischemia: QTd (51,5+/–15,6 vs 65,9+/–21,0ms), QT-sd (15,8+/–5,0 vs 20,1+/–8,0ms) and Tpeak-end (89,6+/–10,5 vs 104,3+/–12,0ms. Strong positive correlation (tau-Kendall=0,78) between QTd and QT-sd was found. Target coronary artery had no influence on investigated parameters - in each subgroup of patients (LAD vs CX vs RCA) parameters increased during ischemia. Among analyzed parameters only QTd was higher in patients with more advanced coronary artery disease before (III vessel vs I vessel: 66,6+/–13,2 vs 79,3+/–15,9ms) and during ischemia (III vessel vs I vessel: 79,3+/–15,9 vs 59,3+/–18,3ms). Left ventricular mass index had no influence on QTd, QT-sd and Tpeak-end. Significant, negative correlation was found between left ventricular ejection fraction and QTd (tau Kendall =-0,31) and QT-sd (tau Kendall =-0,35). Conclusion: During acute myocardial ischemia Tpeak-end time and QT-sd do not alter more than standard QTd. Relative changes of this parameters and differences in varied subgroup of patients are smaller than QTd.
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| 17P-16 HIGH DOSES OF EBASTINE NORMALISE T WAVE MORPHOLOGY M Malik, K Hnatkova, St. George s Hospital Medical School, London, England Practically all non-sedating antihistamines show changes of cardiac repolarisation ranging from torsade initiation (eg. terfenadine) to clinically insignificant small QT prolongation (eg. loratadine). Recently, the regulators suggested that studies of drug-induced repolarisation changes should include morphological T wave changes that have also been found to predict outcome in cardiac patients. Increased follow-up morta |