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Pulse amplitude adjustment provides immediate pacemaker longevity gain
S74
Abstracts / Journal of Electrocardiology 40 (2007) S1 – S77
Poster PAC-18 Effects of cardiac resynchronization therapy on incidence of arrhythmic events in responder and nonresponder patients Aysen Agacdiken, Ahmet Vural, Dilek Ural, Cagatay Durna, Guliz Kozdag, Tayfun Sahin, Teoman Kilic, Ulas Bildirici, Goksel Kahraman, Baki Komsuoglu Department of Cardiology, Kocaeli University Medical Faculty, Kocaeli, Turkey Introduction: The aim of this study was to investigate the effect of cardiac resynchronization therapy (CRT) on incidence of atrial and ventricular arrhythmias in responder and nonresponder patients. Methods: Thirty-six patients (25 male, 11 female, mean age 58 F 10 years) with systolic heart failure and complete left bundle-branch block underwent implantation of biventricular pacemaker. To follow changes in the incidence of supraventricular and ventricular arrhythmias, 24-hour Holter electrocardiographic recordings were performed at the baseline and after 6 months of biventricular stimulation. At the 6-month follow-up, patients were divided into 2 groups according to their response to CRT, defined as a relative increase in left ventricular ejection fraction N25% vs baseline. Results: Six of the patients had atrial fibrillation. In patients with sinus rhythm, the total number of premature atrial beats (PABs) decreased significantly (from 109 F 302 to 7 F 18, P b .001). Premature ventricular beats (PVBs) also decreased in all patients, but the difference was not significant (from 1073 F 2608 to 391 F 611, P = .08). Ventricular tachycardia was detected in 11 patients both at baseline and after 6 months. In responders (n = 26, 72%), total number of PVBs and PABs decreased in 65% and 62% of the patients, respectively, whereas in nonresponders, changes in Holter parameters remained insignificant when compared with baseline (Table 1). Conclusions: Our data suggest that CRT reduces ventricular and atrial arrhythmia burden only in responder patients. Further studies are needed to confirm this finding. Table 1 Holter electrocardiographic parameters of responders and nonresponders Responder LVEF (%) PABs/d PVBs/d VT (n, %)
Nonresponder
Baseline
6th mo
Baseline
6th mo
19 F 7y 199 F 468 565 F 861 7 (27)
33 F 12*,y 9 F 21* 385 F 393* 8 (31)
27 F 9 75 F 211 1268 F 3019 4 (40)
24 F 9 6 F 17 394 F 684 3 (30)
doi:10.1016/j.jelectrocard.2007.03.034
Oral Presentation PAC-19 Incidence and coexisting clinical predictors of inappropriate shock in patients with implantable cardioverter-defibrillators Shu-Ling Lo, Ulrika Birgersdotter-Green Chang Gung Institute of Technology, Tao-Yuan, Taiwan University of California, San Diego, San Diego, CA Introduction: Delivery of appropriate shock(s) significantly decreases the rate of sudden cardiac death from lethal ventricular arrhythmias of implantable cardioverter-defibrillator (ICD) recipients. Inappropriate shock therapy (IST) occurs in 5% to 20% of ICD recipients. Reports have amply described the negative effects of IST. However, existing reports on clinical predictors of IST are limited to single-case studies with small samples or outdated data. This study fills the gap by describing incidence and coexisting clinical predictors of IST in a broad population. Methods: This descriptive cohort study analyzed the incidence and clinical predictors of inappropriate shocks in ICD recipients by using a 5-year retrospective review of ICD interrogation records and medical charts at a university hospital.
Results: During a mean follow-up period of 24.1 F 16.2 months, 20 of 119 ICD recipients received AST; and IST occurred in 13 (9%) of 119 ICD recipients. A total of 16 IST experiences occurred among these 13 patients. Eight subjects received IST for atrial fibrillation (AF)/atria tachycardia: 2 for sinus tachycardia/normal sinus rhythm, 2 for double counting, 1 for lead problems, and 1 for drug interaction. Of these, 12 of 98 men and 1 of 21 women received IST. Using v 2 and logistic regression analysis, results showed only AF as a significant predictor (P = .002 vs .001); and this remains the main cause of IST. Variables of age, sex, New York Heart Association class, ejection fraction, and structural heart disease showed no significant relationships. Triggered IST events during clinical intervention included 1 AF secondary to performing a stress test and another induced by sinus tachycardia secondary to prescribed exercise. Drug device interaction was associated with missing 1 dose of mexiletine. Conclusions: This study offers an initial step in the growing body of knowledge regarding an expanding patient population. Prospectively designed and adequately powered clinical trials are required to establish accurate device algorithms for detection of IST. When planning clinical interventions, the clinical characteristics of patients prone to IST should be carefully considered. Thus, the goal of receiving optimal health monitoring for ICD recipients will be achieved. doi:10.1016/j.jelectrocard.2007.03.035 Posters PAC-20 Pulse amplitude adjustment provides immediate pacemaker longevity gain Nenad Zlatanovic, Sasko Kedev, Nikola Gjorgov, Branislav Miletic, Antonio Georgiev, Dejan Kovacevic, Ivan Trajkov, Vladimir Borozanov, Mitko Kaev, Vladimir Boskov Institute for Heart Diseases, Clinical Center-Skopje, Skopje, Former Yugoslav Republic of Macedonia
Introduction: Adjusting pacemaker pulse amplitude influences the longevity of the pacemaker. Our aim was to establish the initial longevity gain. Methods: Forty randomly selected patients with implanted pacemakers were analyzed. Mean age was 67.35 years. All pacemakers were working on factory settings of pulse amplitude of 3.5 V and pulse width of 0.4 V for an average of 3 years before the adjustment. Initial mean longevity was 68.61 F 18.86 months, mean battery voltage 2.78, and mean battery current 14.21 F 2.61 lA. Results: Pulse amplitude threshold test was performed, and average value of 0.632 F 0.22 V was obtained. Pulse amplitude was programmed to 2.5 V. New readings of battery data were obtained. Battery voltage did not show immediate changes, and battery current decreased to 11.53 F 1.98 lA. New average longevity was projected to 81.03 F 19.82 months, which presents 12.42 months of initial longevity gain with statistical significance at 95% confidence level (P = .003). Positive correlation was found between the new pulse amplitude and new values of battery current (P b .01). Conclusions: Pulse amplitude decrease of only 1 V provides significant initial longevity gain of more than a year. Whether the found correlations between others would have any impact in further longevity gains over longer periods is yet to be established.
doi:10.1016/j.jelectrocard.2007.03.036
PAC-21 Twenty-year experience in cardiac pacing ¨ zgu¨r Ceylan Murat YesSil, Serdar Bayata, Nursen Postac, Erdinc¸ ArVkan, O Cardiology, Atatu¨rk Teaching Hospital, I˙zmir, Turkey Introduction: We investigated the general features of patients (pts) who received permanent cardiac pacemaker in our department between 1987 and 2006.
Abstracts / Journal of Electrocardiology 40 (2007) S1 – S77
Poster PAC-18 Effects of cardiac resynchronization therapy on incidence of arrhythmic events in responder and nonresponder patients Aysen Agacdiken, Ahmet Vural, Dilek Ural, Cagatay Durna, Guliz Kozdag, Tayfun Sahin, Teoman Kilic, Ulas Bildirici, Goksel Kahraman, Baki Komsuoglu Department of Cardiology, Kocaeli University Medical Faculty, Kocaeli, Turkey Introduction: The aim of this study was to investigate the effect of cardiac resynchronization therapy (CRT) on incidence of atrial and ventricular arrhythmias in responder and nonresponder patients. Methods: Thirty-six patients (25 male, 11 female, mean age 58 F 10 years) with systolic heart failure and complete left bundle-branch block underwent implantation of biventricular pacemaker. To follow changes in the incidence of supraventricular and ventricular arrhythmias, 24-hour Holter electrocardiographic recordings were performed at the baseline and after 6 months of biventricular stimulation. At the 6-month follow-up, patients were divided into 2 groups according to their response to CRT, defined as a relative increase in left ventricular ejection fraction N25% vs baseline. Results: Six of the patients had atrial fibrillation. In patients with sinus rhythm, the total number of premature atrial beats (PABs) decreased significantly (from 109 F 302 to 7 F 18, P b .001). Premature ventricular beats (PVBs) also decreased in all patients, but the difference was not significant (from 1073 F 2608 to 391 F 611, P = .08). Ventricular tachycardia was detected in 11 patients both at baseline and after 6 months. In responders (n = 26, 72%), total number of PVBs and PABs decreased in 65% and 62% of the patients, respectively, whereas in nonresponders, changes in Holter parameters remained insignificant when compared with baseline (Table 1). Conclusions: Our data suggest that CRT reduces ventricular and atrial arrhythmia burden only in responder patients. Further studies are needed to confirm this finding. Table 1 Holter electrocardiographic parameters of responders and nonresponders Responder LVEF (%) PABs/d PVBs/d VT (n, %)
Nonresponder
Baseline
6th mo
Baseline
6th mo
19 F 7y 199 F 468 565 F 861 7 (27)
33 F 12*,y 9 F 21* 385 F 393* 8 (31)
27 F 9 75 F 211 1268 F 3019 4 (40)
24 F 9 6 F 17 394 F 684 3 (30)
doi:10.1016/j.jelectrocard.2007.03.034
Oral Presentation PAC-19 Incidence and coexisting clinical predictors of inappropriate shock in patients with implantable cardioverter-defibrillators Shu-Ling Lo, Ulrika Birgersdotter-Green Chang Gung Institute of Technology, Tao-Yuan, Taiwan University of California, San Diego, San Diego, CA Introduction: Delivery of appropriate shock(s) significantly decreases the rate of sudden cardiac death from lethal ventricular arrhythmias of implantable cardioverter-defibrillator (ICD) recipients. Inappropriate shock therapy (IST) occurs in 5% to 20% of ICD recipients. Reports have amply described the negative effects of IST. However, existing reports on clinical predictors of IST are limited to single-case studies with small samples or outdated data. This study fills the gap by describing incidence and coexisting clinical predictors of IST in a broad population. Methods: This descriptive cohort study analyzed the incidence and clinical predictors of inappropriate shocks in ICD recipients by using a 5-year retrospective review of ICD interrogation records and medical charts at a university hospital.
Results: During a mean follow-up period of 24.1 F 16.2 months, 20 of 119 ICD recipients received AST; and IST occurred in 13 (9%) of 119 ICD recipients. A total of 16 IST experiences occurred among these 13 patients. Eight subjects received IST for atrial fibrillation (AF)/atria tachycardia: 2 for sinus tachycardia/normal sinus rhythm, 2 for double counting, 1 for lead problems, and 1 for drug interaction. Of these, 12 of 98 men and 1 of 21 women received IST. Using v 2 and logistic regression analysis, results showed only AF as a significant predictor (P = .002 vs .001); and this remains the main cause of IST. Variables of age, sex, New York Heart Association class, ejection fraction, and structural heart disease showed no significant relationships. Triggered IST events during clinical intervention included 1 AF secondary to performing a stress test and another induced by sinus tachycardia secondary to prescribed exercise. Drug device interaction was associated with missing 1 dose of mexiletine. Conclusions: This study offers an initial step in the growing body of knowledge regarding an expanding patient population. Prospectively designed and adequately powered clinical trials are required to establish accurate device algorithms for detection of IST. When planning clinical interventions, the clinical characteristics of patients prone to IST should be carefully considered. Thus, the goal of receiving optimal health monitoring for ICD recipients will be achieved. doi:10.1016/j.jelectrocard.2007.03.035 Posters PAC-20 Pulse amplitude adjustment provides immediate pacemaker longevity gain Nenad Zlatanovic, Sasko Kedev, Nikola Gjorgov, Branislav Miletic, Antonio Georgiev, Dejan Kovacevic, Ivan Trajkov, Vladimir Borozanov, Mitko Kaev, Vladimir Boskov Institute for Heart Diseases, Clinical Center-Skopje, Skopje, Former Yugoslav Republic of Macedonia
Introduction: Adjusting pacemaker pulse amplitude influences the longevity of the pacemaker. Our aim was to establish the initial longevity gain. Methods: Forty randomly selected patients with implanted pacemakers were analyzed. Mean age was 67.35 years. All pacemakers were working on factory settings of pulse amplitude of 3.5 V and pulse width of 0.4 V for an average of 3 years before the adjustment. Initial mean longevity was 68.61 F 18.86 months, mean battery voltage 2.78, and mean battery current 14.21 F 2.61 lA. Results: Pulse amplitude threshold test was performed, and average value of 0.632 F 0.22 V was obtained. Pulse amplitude was programmed to 2.5 V. New readings of battery data were obtained. Battery voltage did not show immediate changes, and battery current decreased to 11.53 F 1.98 lA. New average longevity was projected to 81.03 F 19.82 months, which presents 12.42 months of initial longevity gain with statistical significance at 95% confidence level (P = .003). Positive correlation was found between the new pulse amplitude and new values of battery current (P b .01). Conclusions: Pulse amplitude decrease of only 1 V provides significant initial longevity gain of more than a year. Whether the found correlations between others would have any impact in further longevity gains over longer periods is yet to be established.
doi:10.1016/j.jelectrocard.2007.03.036
PAC-21 Twenty-year experience in cardiac pacing ¨ zgu¨r Ceylan Murat YesSil, Serdar Bayata, Nursen Postac, Erdinc¸ ArVkan, O Cardiology, Atatu¨rk Teaching Hospital, I˙zmir, Turkey Introduction: We investigated the general features of patients (pts) who received permanent cardiac pacemaker in our department between 1987 and 2006.