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  • 2000-2004  (10)
  • 1
    Electronic Resource
    Electronic Resource
    High-Flow Perfusion of Sheaths for Prevention of Thromboembolic Complications During Complex Catheter Ablation in the Left Atrium (2004)
    350 Main Street , Malden , MA 02148-5018 , USA , and 9600 Garsington Road , Oxford OX4 2DQ , UK . : Blackwell Science Inc
    Journal of cardiovascular electrophysiology 15 (2004), S. 0 
    Details
    ISSN: 1540-8167
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Introduction: Mechanisms for thromboembolic complications during complex ablation procedures in left atrium (LA) have not been defined. The aim of this study was to determine the effect of the perfusion rate of the transseptal sheath on the incidence of thromboembolic complications during catheter ablation for atrial fibrillation (AF) or LA macroreentrant tachycardia. Methods and Results: We analyzed clinical and procedural data from 86 consecutive patients (153 procedures) referred for catheter ablation of AF (74 patients) or LA macroreentrant tachycardia (12 patients). The transseptal sheath was continuously perfused at a low flow rate (3 mL/hour) for the first 32 patients and at a high flow rate (180 mL/hour) for the subsequent 54 patients. Ablation was mainly performed using map-guided isolation of pulmonary veins for AF and three-dimensional electroanatomic mapping for LA macroreentrant tachycardia. Five patients (6% of patients and 3.5% of procedures) developed a cerebral thromboembolic complication, all during procedures using low-flow perfusion. Sheath perfusion rate and total procedure duration were the two variables significantly associated with the occurrence of stroke (P = 0.013 and 0.001, respectively). After adjustment in a multivariable analysis, sheath perfusion rate remained the only risk factor for stroke. The risk was 17 times higher using low-flow than high-flow perfusion (odds ratio 17.26, 95% confidence interval 1.14–260.81, P = 0.04). No other clinical or procedural parameters had any significant effect. Conclusion: Sheath perfusion rate is an important determinant of the risk factor for stroke during complex LA ablation procedures. Continuous high-flow perfusion appears to be effective in preventing this complication. (J Cardiovasc Electrophysiol, Vol. 15, pp. 276-283, March 2004)
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1046/j.1540-8167.2004.03401.x
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  • 2
    Electronic Resource
    Electronic Resource
    Study of Precursors of Ventricular Tachycardia from Data Stored in the Memory of a Dual Chamber Implantable Cardioverter Defibrillator (2003)
    350 Main Street , Malden , MA 02148-5018 , USA , and 9600 Garsington Road , Oxford OX4 2DQ , UK . : Blackwell Futura Publishing, Inc.
    Pacing and clinical electrophysiology 26 (2003), S. 0 
    Details
    ISSN: 1540-8159
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: This study was performed to examine precursors of ventricular tachyarrhythmias in patients who experienced a sustained ventricular tachyarrhythmia and received appropriate therapy by ICD. From an overall consecutive population of 77 patients, 18 patients (1 woman, mean age 61.7 ± 10.8 years ) were selected for having experienced a sustained ventricular tachyarrhythmia and received at least one appropriate ICD therapy preceded by 20 minutes of internal information. The number of premature ventricular complexes (PVCs)/min for each of the 20 minutes preceding the onset of ventricular tachyarrhythmia, the shortest coupling intervals between PVC and normal sinus beat, and the presence of short-long-short (SLS) interval sequences were examined. Data were stratified according to underlying disease, left ventricular ejection fraction, rate of ventricular tachyarrhythmia, and antiarrhythmic therapy. One hundred twenty-eight episodes of spontaneous ventricular tachyarrhythmia were retrieved. Rapid ventricular tachyarrhythmia (〉160 beats/min) were preceded by a significantly greater mean number (3.71 ± 6.36) of PVCs than slower ventricular tachyarrhythmia (≤160 beats/min) (0.63 ± 0.88, P = 0.0004) . The mean shortest PVC coupling interval was significantly shorter in patients with (588 ± 99 ms) versus without (643 ± 111 ms, P = 0.03) ischemic heart disease, before episodes of rapid (527 ± 55 ms) versus slower (636 ± 105 ms, P = 0.0001) ventricular tachyarrhythmia, and in the absence (538 ± 80 ms) versus the presence (620 ± 105 ms, P = 0.006) of amiodarone. SLS sequences preceded 29% of rapid ventricular tachyarrhythmic episodes, versus 8% of the slower ventricular tachyarrhythmia (P 〈 0.01) . Significant differences were found in the characteristics of PVCs preceding ventricular tachyarrhythmic episodes in accordance to their rate and the underlying cardiomyopathy. Though insufficient in isolation, these findings may be helpful when combined with other observations to develop preventive algorithms, or to refine the programming of implantable devices. (PACE 2003; 26[Pt. I]:1454–1460)
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1046/j.1460-9592.2003.t01-1-00210.x
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  • 3
    Electronic Resource
    Electronic Resource
    Ventricular Coupling of Electrical and Mechanical Dyssynchronization in Heart Failure Patients (2002)
    Oxford, UK : Blackwell Futura Publishing, Inc.
    Pacing and clinical electrophysiology 25 (2002), S. 0 
    Details
    ISSN: 1540-8159
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: TOUSSAINT, J-F., et al.: Ventricular Coupling of Electrical and Mechanical Dyssynchronization in Heart Failure Patients. We studied the relationships of electrical and mechanical synchronization in patients with heart failure (CHF) and various degree of ventricular conduction delays. Ninety-two CHF patients (60 ± 13 years old, LVEF 〈 45%), NYHA II-III-IV, and 35 age-matched control subjects were studied with angioscintigraphic phase analysis. We measured ejection fractions (LVEF, RVEF) and calculated the total activation time for the left (TtLV) and right ventricle (TtRV), and the synchronization time between right and left ventricle (TRVLV), and between LV apex and base (Tab). Patients were divided into three groups according to QRS duration: group 1 〈 120 ms (n = 28), group 2 〈 150 ms (n = 23), group 3 ≥ 150 ms (n = 41). In group 1: LVEF = 31.1 ± 10.9%, RVEF = 30.1 ± 12.6%, TtLV = 204 ± 70 ms, TtRV = 183 ± 61 ms, TRVLV = 7 ± 33 ms, Tab = 29 ± 23 ms. In group 2, these were: 27.8 ± 9.1%, 27.8 ± 8.8%, 227 ± 95 ms, 248 ± 137 ms, 35 ± 42 ms*, and 39 ± 53 ms respectively. In group 3: LVEF = 20.5 ± 9.5%†, RVEF = 28.4 ± 16.1%, TtLV = 304 ± 155 ms†, TtRV = 234 ± 106 ms†, TRVLV = 64 ± 42 ms†, and Tab = 67 ± 48 ms*, all P 〈 0.001 versus controls *P 〈 0.05 versus G1, †P ≤ 0.01 versus G1. A significant relation links QRS to both inter- and intraventricular asynchrony (TRVLV: r = 0.65; TtLL: r = 0.70, Tab: r = 0.60), and to LV function (r = 0.72); while LVEF relates more closely to intraventricular asynchrony: TtLV (r = 0.52), TtLL (r = 0.67), than to interventricular asynchrony: TRVLV (r = 0.48); P 〈 0.01, P ≤ 0.001. In CHF patients, electromechanical and contractile alterations are coupled; regional activation may be an early parameter allowing the detection of ventricular dyssynchronization.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1046/j.1460-9592.2002.00178.x
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  • 4
    Electronic Resource
    Electronic Resource
    Temporal and Geographical Trends in Indications for Implantation of Cardiac Defibrillators in Europe 1993–1998 (2000)
    Oxford, UK : Blackwell Publishing Ltd
    Pacing and clinical electrophysiology 23 (2000), S. 0 
    Details
    ISSN: 1540-8159
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Despite the demonstrated efficacy of implantable cardioverter defibrillators (ICDs) in reducing sudden and total mortality in selected populations, their implantation rates vary greatly between countries. The aim of our study was to analyze temporal and geographical trends in ICD implantations in countries with similar health related expenditure in Western Europe. A total of 2,257 patients from ten European evaluation studies of Medtronic defibrillators and defibrillation electrodes, conducted between 1993 and 1998, representing 12 countries, was included in this analysis. Rates of implantation and clinical characteristics were compared between countries and years of implantation. Rates of implantation differed greatly between Western European countries and did not correlate with indices of health related expenditure (i.e., number of patients per physician and number of patients per hospital bed). However, there was a strong and statistically significant negative correlation between the use of amiodarone and the rates of implantation (r =−0.66, P = 0.02). Temporal trends showed a significant increase in the age of the patients receiving an ICD between 1993 and 1998(57 ± 14 vs 61 ± 12years, mean ± SD, P 〈 0.001). There was also a temporal trend towards an increased incidence of coronary artery disease and a significant decrease in the incidence of cardiomyopathy. There was a temporal increase in implantations in patients with a history of ventricular tachycardia. Despite a general scientific agreement that ICDs are a first line treatment for patients at high risk of sudden cardiac death, their acceptance remains low in several developed countries. This low acceptance may not be entirely related to budget constraint but may also be related to their perceived efficacy by physicians and health authorities.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1540-8159.2000.tb00884.x
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  • 5
    Electronic Resource
    Electronic Resource
    High Incidence of Sudden Death with Conduction System and Myocardial Disease Due to Lamins A and C Gene Mutation (2000)
    Oxford, UK : Blackwell Futura Publishing, Inc.
    Pacing and clinical electrophysiology 23 (2000), S. 0 
    Details
    ISSN: 1540-8159
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: BÉCANE, H.–M., et al.: High Incidence of Sudden Death with Conduction System and Myocardial Disease Due to Lamins A and C Gene Mutation. We studied 54 living relatives from a large French kindred, among which 17 members presented with a cardiomyopathy transmitted on an autosomal dominant mode. Five of these individuals had clinical manifestations of muscle disease phenotypically consistent with Emery-Dreifuss muscular dystrophy. Genetic analysis of this kindred had demonstrated a nonsense mutation in the LMNA gene located on chromosome 1q11–q23. This gene encodes lamins A and C, proteins of the nuclear lamina located on the inner face of the nuclear envelope. We retrospectively determined the cause of death of 15 deceased family members, 8 of whom had died suddenly, 2 as a first and single manifestation of the disease. The six other cases had histories of arrhythmias and left ventricular dysfunction before dying suddenly, and three of them died despite the prior implantation of a permanent pacemaker. The mean age of onset of cardiac symptoms among affected living family members was 33 years (range 15–47 years), and the first symptoms were due to marked atrioventricular conduction defects or sinus dysfunction, requiring the implantation of permanent pacemakers in seven cases. Myocardial dysfunction accompanied by ventricular arrhythmias developed rapidly in the course of the disease and resulted in severe dilated cardiomyopathy requiring cardiac transplantation in three cases. In conclusion, in patients presenting a life-threatening familial or sporadic cardiac restricted phenotype similar to that described here, mutations in the lamins A and C gene should be looked for. In the genotypically affected individuals, cardiological and electrophysiological follow-up should be performed to prevent sudden death that could occur rapidly in the evolution of such disease.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1046/j.1460-9592.2000.01661.x
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  • 6
    Electronic Resource
    Electronic Resource
    Cost Analysis of Catheter Ablation for Paroxysmal Atrial Fibrillation (2003)
    350 Main Street , Malden , MA 02148-5018 , USA . : Blackwell Futura Publishing, Inc.
    Pacing and clinical electrophysiology 26 (2003), S. 0 
    Details
    ISSN: 1540-8159
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: WEERASOORIYA, R., et al.: Cost Analysis of Catheter Ablation for Paroxysmal Atrial Fibrillation. RF ablation for paroxysmal atrial fibrillation (PAF) is a curative treatment, which when successful, eliminates the need to take antiarrhythmic drugs, be anticoagulated, and have recurrent physician visits or hospital admissions. The authors performed a retrospective cost comparison of RF ablation versus drug therapy for PAF. The study population consisted of 118 consecutive patients with symptomatic, drug refractory PAF who underwent1.52 ± 0.71RF ablation procedures (range 1–4) for PAF. During a follow-up of 32 ± 15 weeks, 85 (72%) patients remained free of clinical recurrence in absence of antiarrhythmic drugs. The cost of RF ablation was calculated in the year 2001 euros on the basis of resource use. The mean cost of pharmacologic treatment prior to ablation was 1,590 euros/patient per year. The initial cost of RF ablation for PAF was 4,715 euros, then 445 euros/year. After 5 years, the cost of RF ablation was below that of ongoing medical management, and continued to diverge thereafter. RF catheter ablation may be a cost-effective alternative to long-term drug therapy in patients with symptomatic, drug refractory PAF. (PACE 2003; 26[Pt. II]:292–294)
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1046/j.1460-9592.2003.00035.x
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  • 7
    Electronic Resource
    Electronic Resource
    Safety and Efficacy of a Dual Chamber Implantable Cardioverter Defibrillator Capable of Slow Ventricular Tachycardia Discrimination: (2003)
    350 Main Street , Malden , MA 02148-5018 , U.S.A . : Blackwell Publishing
    Pacing and clinical electrophysiology 26 (2003), S. 0 
    Details
    ISSN: 1540-8159
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: New developments in dual chamber implantable cardioverter defibrillators (ICD) have increased the specificity of therapy delivery. This study was performed to examine the performance of an algorithm, focusing on its ability to distinguish slow ventricular tachycardia (VT) from sinus rhythm or supraventricular tachyarrhythmias. The patient population included 77 men and 13 women, 63 ± 11 years old, treated with ICDs after episodes of spontaneous or inducible ventricular tachyarrhythmias. They were randomized to programming of the ICD to a lower limit of VT detection at 128 beats/min (group I, n = 44), versus 153 beats/min II (group II, n = 46). The primary endpoint of the study consisted of comparing the specificity and sensitivity of the algorithm between the two groups of patients. Over a 10.1 ± 3.5 months follow-up, 325 episodes were detected in the Tachy zone in group I, versus 106 in group II. The sensitivity and specificity of the algorithm in group I were 98.8% and 94.4%, respectively, versus 100% and 89% in group II (NS). A single episode of VT at a rate of 132 beats/min was diagnosed as SVT in group I. The sensitivity and specificity of the algorithm for tachycardias 〈153 beats/min were 97.4% and 94.5%, respectively. Overall VT therapy efficacy was 100% in both groups. The performance of this algorithm in the slow VT zone supports the programming of a long Tachy detection interval to document slow events, and allows to treat slow VT, if necessary, without significant risk of inappropriate interventions for sinus tachycardia. (PACE 2003; 26:2275–2282)
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1540-8159.2003.00359.x
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  • 8
    Electronic Resource
    Electronic Resource
    Basal Asynchrony and Resynchronization with Biventricular Pacing Predict Long-Term Improvement of LV Function in Heart Failure Patients (2003)
    350 Main Street , Malden , MA 02148-5018 , USA , and 9600 Garsington Road , Oxford OX4 2DQ , UK . : Blackwell Futura Publishing, Inc.
    Pacing and clinical electrophysiology 26 (2003), S. 0 
    Details
    ISSN: 1540-8159
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Biventricular pacing (BiV) is emerging for patients with dilated cardiomyopathy (DCM) and asynchrony. We measured basal asynchrony and early resynchronization by radionuclide angioscintigraphy (RNA) in order to predict long-term evolution of ventricular function after BiV. Thirty-four patients (NYHA Class III–IV, 65.4 ± 11 years ) with large QRS (179 ± 18 ms) were implanted with BiV and studied by RNA before (D0), at day 8 (D8), and during follow-up (20 ± 7 months) . We calculated left and right ejection fractions, the interventricular dyssynchrony (TRVLV), and the apicobasal dyssynchrony (Tab). LVEF improved from 20.2 ± 8.1% (D0) to 27.1%± 12.6% (follow-up, P 〈 0.003 vs D0) and RVEF from 28.6%± 13% (D0) to 34.3 ± 11.5% (follow-up, P 〈 0.03 vs D0). Inter- (ΔTRVLV) and intraventricular resynchronization was immediate and remained stable: TRVLV decreased from 68.3 ± 38 ms (D0) to 13.4 ± 48.5 ms (D8) and 1.8 ± 39.2 ms (follow-up, P 〈 0.0001 vs D0); and Tab from 45.8 ± 64.1 ms to −18 ± 68 (D8) and −28.3 ± 53.6 ms (follow-up, P 〈 0.0001 vs D0). Early inter- and intraventricular resynchronization (ΔTab) at D8 were related to late LVEF and RVEF improvement. Together, an LVEF 〉 15% and a significant interventricular dyssynchrony (TRVLV 〉 60 ms) at D0 have a sensitivity of 79% and a positive predictive value of 83% to predict an improvement of LVEF superior to 5% at follow-up. In DCM patients, BiV resynchronizes ventricles early and in the long-term, while RVEF and LVEF improve progressively. Patients with large electromechanical dyssynchrony benefit most from BiV. (PACE 2003; 26:1815–1823)
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1046/j.1460-9592.2003.t01-1-00275.x
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  • 9
    Electronic Resource
    Electronic Resource
    Long-Term Experience with a Preshaped Left Ventricular Pacing Lead (2003)
    350 Main Street , Malden , MA 02148-5018 , USA . : Blackwell Futura Publishing, Inc.
    Pacing and clinical electrophysiology 26 (2003), S. 0 
    Details
    ISSN: 1540-8159
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: OLLITRAULT, J., et al.: Long-Term Experience with a Preshaped Left Ventricular Pacing Lead. This study describes a long-term experience with a new LV pacing lead. The study population consisted of 62 patients (85% men, 71 ± 10 years old) with advanced dilated cardiomyopathy, in NYHA Class III or IV despite optimal drug therapy, and a QRS duration 〉150 ms. Patients in sinus rhythm were implanted with a triple chamber pacemaker to maintain atrioventricular synchrony. A dual chamber pacemaker was implanted in patients in atrial fibrillation for biventricular pacing only. A clinical evaluation and interrogation of the resynchronization pacemaker were performed at implant, at 1 week (W1), one (M1), four (M4), and seven (M7) months after implantation. A longer follow-up (2 years) is available for patients implanted at the authors institution. LV measurements were pacing threshold at 0.5-ms pulse duration and pacing impedance. R wave amplitude (mV) was measured at the time of implantation only. The system was successfully implanted in 86% of patients with the latest design of the lead. Mean R wave amplitude at implant was 15 ± 7 mV and mean pacing impedance was 1054 ± 254 Ω . Between implant (n = 38) and M7 (n = 15) , pacing threshold rose from0.73 ± 0.54to1.57 ± 0.60 V (P 〈 0.001). In conclusion, the situs lead was successfully implanted in a high percentage of patients. In addition, low pacing threshold and high impedance measured during follow-up are consistent with a low pacing current drain, ensuring a durable pulse generator longevity. (PACE 2003; 26[Pt. II]:185–188)
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1046/j.1460-9592.2003.00013.x
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  • 10
    Electronic Resource
    Electronic Resource
    Management of Atrial Tachyarrhythmias: Benefits of Pacemaker Diagnostics (2003)
    350 Main Street , Malden , MA 02148-5018 , USA . : Blackwell Futura Publishing, Inc.
    Pacing and clinical electrophysiology 26 (2003), S. 0 
    Details
    ISSN: 1540-8159
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: FAUCHIER, L., et al.: Management of Atrial Tachyarrhythmias: Benefits of Pacemaker Diagnostics. The aim of this prospective multicenter study was to assess the clinical benefits of the Selection (Vitatron) pacemaker diagnostic functions (AF 1.0) in the management of AF. Forty patients ( 71 ± 9  years of age), with documented AF and conventional pacing indications, received a Selection. The AF 1.0 function of the pacemaker was programmed to document the AF burden, onset, daily distribution, duration, premature atrial beats before onset, and mode of onset of the last 12 episodes for AF episodes exceeding 180 beats/min. By comparing patients' symptoms records, patient conventional assessment at follow-up and AF 1.0 data, the investigators evaluated the usefulness of AF 1.0 in AF management at 3- and 6-month follow-ups. Usefulness was defined as a change in arrhythmia management prompted by the disclosure of AF 1.0 data. AF recurrences were recorded in 71% of the follow-ups with symptoms reported by patients in only 16%. Thirty-nine percent of therapeutic changes based on conventional assessment were confirmed by AF 1.0 data, and in 61% of instances, the initial changes were modified by AF 1.0 data. Changes included pacing parameters in 56% of cases, AF prevention with pacing algorithms in 37%, and medical treatment in 7%. All investigators indicated that AF 1.0 was useful in all patients. The AF 1.0 diagnostic functions offered a unique documentation of AF in asymptomatic patients, and allowed therapeutic adjustments impossible otherwise. (PACE 2003; 26[Pt. II]:233–238)
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1046/j.1460-9592.2003.00023.x
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