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Optimizing single-chamber pacing in dogs. Part 2: Rate adaptive pacing

VETERINARY JOURNAL 2021年 272卷 105630-105630页

作者： Molise, N. Sydney Flanders, Wyatt H. Flanders, Nicholas H. Pariaut, Romain Cornell Univ Coll Vet Med Dept Clin Sci Sect Cardiol Ithaca NY 14853 USA Univ Washington Dept Phys Seattle WA 98195 USA OPUS 12 Inc Berkeley CA 94710 USA

Proper programming of pacemakers for dogs in the rate adaptive mode requires an understanding of the rate requirements for each individual and the interplay of programmable features. The specific advantages and disadvantages of the rate adaptive mode should be considered on a case by case basis. Fundamentally, two components are linked in the implementation of rate adaptive pacing: (1) sensing the need for a change in rate and(2) responding with the appropriate alteration in pacing rate. The programming interaction of these two components are interdependent and affected by the rates programmed. These features may be adjusted manually or automatically. In this review (Part 2 of a two-part review) the considerations required to program each aspect that optimizes the pacing rate profile are reviewed. These include the lower rate, upper sensor rate, activities of daily life rate, sensor threshold, acceleration and deceleration, slope, activities of daily life zone, exertion zone, automatic versus manual adjustments and closed loop stimulation. The programming features of pacemakers manufactured by three companies are summarized (Abbott, formerly St. Jude;Biotronik/Dextronix;Medtronic). Means of assessing the success of pacemaker programing is examined through examples of pacemaker data, Holter analysis, Poincare plots and tachograms. Finally, the questions and considerations for rate adaptive pacing in dogs that demand investigation are proposed. (C) 2021 Elsevier Ltd. All rights reserved.

关键词： pacemaker programming Poincare plot Right ventricular pacing in the dog Rate adaptive/responsive pacing

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Optimizing single-chamber pacing in dogs Part 1: Rate determinations, rate interventions and hysteresis

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VETERINARY JOURNAL 2021年 272卷 105650-105650页

作者： Moise, N. Sydney Flanders, Wyatt H. Flanders, Nicholas H. Pariaut, Romain Cornell Univ Coll Vet Med Dept Clin Sci Sect Cardiol Ithaca NY 14853 USA Univ Washington Dept Phys Seattle WA 98195 USA OPUS 12 Inc Berkeley CA 94710 USA

Determining ideal pacing rates to meet physiological needs and optimizing programming to prevent unnecessary right ventricular pacing in dogs requires an understanding of heart rate profiles and applicable pacing technology. The heart rate and rhythm of the dog is complex necessitating investigation of rate requirements of activity and circadian influences. Overlaying this information are a multiplicity of other factors such as age, breed, temperament, cardiovascular disease and underlining rhythm disorders that contribute to the difficulty in making general conclusions. However, all such information permits better implementation of programming options with the goal of better outcomes. In this review (Part 1 of a two-part review) instantaneous heart rate, rolling average heart rate, simple average heart rate, heart rate tachograms, RR interval tachograms (2D, 3D and dynamic), and Poincar & eacute;plots (2D, 3D and dynamic) are discussed as they apply to decisions in the determination and examination of pacing rates for dogs programmed in the VVI pacing mode (Ventricular paced, Ventricular sensed, Inhibited pacing). The applicable pacing operations available for three pacemaker companies are reviewed (Abbott, Biotronik/Dextronix, and Medtronic). The programmable options considered include: slowest pacing rate without additional features to extend the pacing interval, sleep/rest rate preferences, hysteresis to lengthen pacing interval following intrinsic beats, and intermittent increases in pacing following abrupt loss of intrinsic rhythm. Recommendations are suggested for follow-up of individual dogs with examination of pacing statistics and Holter monitoring. (c) 2021 Elsevier Ltd. All rights reserved.

关键词： Holter monitoring pacemaker programming Poincar? plot Right ventricular pacing Sinus node dysfunction

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The Symptoms and Clinical events associated with Automatic Reprogramming (SCARE) at replacement notification study

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PACE-PACING AND CLINICAL ELECTROPHYSIOLOGY 2018年第12期41卷 1611-1618页

作者： Sinha, Sunil K. Carlson, Daniel Chrispin, Jonathan Barth, Andreas S. Rickard, John Jack Spragg, David D. Berger, Ronald Love, Charles Calkins, Hugh Tomaselli, Gordon F. Marine, Joseph E. Johns Hopkins Univ Sch Med Div Cardiol Baltimore MD USA Cleveland Clin Dept Cardiovasc Med Cleveland OH 44106 USA Albert Einstein Coll Med Dept Med Cardiol New York NY USA

Background pacemaker patients experience battery depletion that activates pacemaker's alert for replacement notification. Automatic reprogramming at replacement notification can result in loss of rate response and atrioventricular (AV) synchrony. Objective To determine if relevant symptoms or clinical events may be associated with automatic reprogramming at replacement notification. Methods Electronic medical record review was undertaken for 298 patients referred for pacemaker generator replacement. Primary endpoints were symptoms or clinical events during replacement notification period. Results Following elimination of duplicate pacemaker replacements (n = 12), "near-replacement notification" or "recalled" (n = 15) and pacemakers at "end of life" (n = 5), 266 subjects were included. Three distinct reprogramming cohorts were identified;those with no change (control) in pacing mode (n = 46), those with loss of rate response (n = 154), and those with loss of AV synchrony +/- rate response (n = 66). In total, 83 subjects (31.2%) had symptoms with significant differences seen between groups (control = 4.3%, loss of rate response = 26.0%, loss of AV synchrony +/- rate response = 62.1%, P < 0.001). Overall, 28 subjects (10.5%) experienced clinical events with significant differences seen between groups (control = 0.0%, loss of rate response = 6.5%, loss of AV synchrony +/- rate response = 27.3%, P < 0.001). Conclusions Automatic reprogramming at replacement notification was associated with significant symptoms in 26% of those who lost rate response and in 62% of those who lost AV synchrony +/- rate response. Additionally, 27% of the latter cohort required nonelective clinical care.

关键词： elective replacement indication elective replacement time pacemaker pacemaker mode pacemaker programming recommended replacement time

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Analysis of pacemaker ECGs

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Herzschrittmachertherapie und Elektrophysiologie 2015年第3期26卷 260-273页

作者： Israel, Carsten W. Ekosso-Ejangue, Lucy Sheta, Mohamed-Karim Klinik für Innere Medizin – Kardiologie Diabetologie & Nephrologie Evangelisches Krankenhaus Bielefeld Burgsteig 13 Bielefeld 33617 Germany

Introduction: The key to a successful analysis of a pacemaker electrocardiogram (ECG) is the application of the systematic approach used for any other ECG without a pacemaker: analysis of (1) basic rhythm and rate, (2) QRS axis, (3) PQ, QRS and QT intervals, (4) morphology of P waves, QRS, ST segments and T(U) waves and (5) the presence of arrhythmias. Methods: If only the most obvious abnormality of a pacemaker ECG is considered, wrong conclusions can easily be drawn. If a systematic approach is skipped it may be overlooked that e.g. atrial pacing is ineffective, the left ventricle is paced instead of the right ventricle, pacing competes with intrinsic conduction or that the atrioventricular (AV) conduction time is programmed too long. Apart from this analysis, a pacemaker ECG which is not clear should be checked for the presence of arrhythmias (e.g. atrial fibrillation, atrial flutter, junctional escape rhythm and endless loop tachycardia), pacemaker malfunction (e.g. atrial or ventricular undersensing or oversensing, atrial or ventricular loss of capture) and activity of specific pacing algorithms, such as automatic mode switching, rate adaptation, AV delay modifying algorithms, reaction to premature ventricular contractions (PVC), safety window pacing, hysteresis and noise mode. Conclusion: A systematic analysis of the pacemaker ECG almost always allows a probable diagnosis of arrhythmias and malfunctions to be made, which can be confirmed by pacemaker control and can often be corrected at the touch of the right button to the patient’s benefit. © 2015, Springer-Verlag Berlin Heidelberg.

关键词： Endless loop tachycardia Malfunction pacemaker ECG pacemaker programming Safety window pacing

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Unusual Interval Plot in a Patient with a Dual-Chamber Implantable Cardioverter-Defibrillator

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JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY 2014年第9期25卷 1034-1035页

作者： Enriquez, Andres Ali, Fariha Sadiq Baranchuk, Adrian Ellenbogen, Kenneth A. Queens Univ Div Cardiol Kingston ON K7L 2V7 Canada Virginia Commonwealth Univ Dept Med Sch Med Richmond VA 23298 USA

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Current status of atrial pacing algorithms for the prevention of atrial fibrillation: Should algorithms be used?

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JOURNAL OF ARRHYTHMIA 2014年第2期30卷 77-81页

作者： Nakai, Toshiko Watanabe, Ichiro Hirayama, Atsushi Nihon Univ Sch Med Dept Med Div Cardiol Itabashi Ku 30-1 Oyaguchi Kami cho Tokyo 1738610 Japan

Since the development of an atrial pacing algorithm for preventing atrial fibrillation (AF), approximately 20 years ago, many clinical trials have demonstrated the effectiveness of atrial pacing with respect to AF prevention. Nevertheless, the actual effectiveness of AF suppression via atrial pacing remains under debate, and no definitive conclusion has been reached. The AF suppression algorithms embedded in pacemakers have not demonstrated an unequivocal clinical efficacy that would support changing of the guidelines to recommend such algorithms. In this review of studies conducted since 2006, we discuss the efficacies of these AF suppression algorithms and their usefulness in patients requiring pacemaker implantation. (C) 2014 Japanese Heart Rhythm Society. Published by Elsevier B.V. All rights reserved.

关键词： Atrial fibrillation pacemaker programming Atrial pacing Arrhythmia prevention algorithm

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Contributions of a Hemodynamic Sensor Embedded in an Atrial Lead in a Porcine Model

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JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY 2011年第5期22卷 579-583页

作者： Bordachar, Pierre Garrigue, Stephane Ritter, Philippe Ploux, Sylvain Labrousse, Louis Casset, Cyril Haissaguerre, Michel Dos Santos, Pierre Univ Bordeaux 2 F-33076 Bordeaux France Univ Hosp Bordeaux Bordeaux France Clin St Augustin Bordeaux France

Introduction: Preliminary studies have revealed a high correlation between peak endocardial acceleration ( PEA) measured with a sensor embedded in a ventricular lead and human cardiac contractility. In this study we assessed ( 1) the contributions made by measurements of PEA1, an index of ventricular systolic contraction, from the right atrium, and ( 2) the feasibility of recording a fourth component of PEA (PEA4), coincident with atrial contraction and corresponding to the phonocardiographic fourth heart sound. Methods: We placed a PEA sensor embedded at the tip of a right atrial lead in 9 pigs. A 7F Millar catheter tip micromanometer was introduced into the left ventricular (LV) cavity to measure dP/dt(max). Myocardial contractility was increased by infusion of dobutamine and depressed by the infusion of esmolol. We searched, during VDD pacing, for PEA4 following atrial systole, while gradually lengthening the atrioventricular delay. Ventricular fibrillation was then triggered by rapid stimulation. Results: The changes in PEA1 were correlated with the changes in LV dP/dt(max) (r = 0.91;P < 0.001). A low-frequency component of the endocardial signal (PEA4) was visible approximately 50 milliseconds after the atrial electrogram in all experiments. Following the induction of ventricular fibrillation, PEA4 remained visible on the endocardial recording, simultaneous with the sensed atrial electrogram. Conclusions: This study confirms the merit of embedding a PEA sensor in an atrial lead. The exploitation of the information provided by the PEA1 signal remains pertinent and the possibility to record an additional PEA4 component offers the perspective of new clinical applications. (J Cardiovasc Electrophysiol, Vol. 22, pp. 579-583 May 2011).

关键词： atrial pacing heart failure hemodynamic sensor pacemaker programming peak endocardial acceleration physiologic sensor

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Bradycardia pacing

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Medicine (United Kingdom) 2010年第9期38卷 526-529页

作者： Brown, Benjamin D. Fox, David J. Benjamin D Brown MBChB MRCP MD is a Consultant Cardiologist/Electrophysiologist University Hospital of South Manchester NHS Trust Manchester UK. Competing interests: none declared

pacemakers though technologically complex are fundamentally simple once an understanding of the components and language is achieved. This review aims to provide that knowledge to reassure the clinician over a device that is frequently found on medical and surgical wards. Despite pacemakers being cost effective and increasingly commonplace they remain underutilized. Therefore we also aim to equip the reader with the key principles to identify individuals who may benefit from pacemaker implant. © 2010

关键词： bradycardia heart block pacemaker pacemaker programming pacing indication

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Tissue Doppler echocardiography and biventricular pacing in heart failure: Patient selection, procedural guidance, follow-up, quantification of success

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Cardiovascular Ultrasound 2004年第1期2卷 1-13页

作者： Knebel, Fabian Reibis, Rona Katharina Bondke, Hans-Jürgen Witte, Joachim Walde, Torsten Eddicks, Stephan Baumann, Gert Borges, Adrian Constantin Charité Campus Mitte University Medicine Berlin Med. Clin. Cardiol. Angiol. P. 10098 Berlin Germany Klinik am See Department of Cardiology Rehab. Ctr. of Cardiovasc. Diseases 15562 Rüdersdorf (Berlin) Seebad 84 Germany

Asynchronous myocardial contraction in heart failure is associated with poor prognosis. Resynchronization can be achieved by biventricular pacing (BVP), which leads to clinical improvement and reverse remodeling. However, there is a substantial subset of patients with wide QRS complexes in the electrocardiogram that does not improve despite BVP. QRS width does not predict benefit of BVP and only correlates weakly with echocardiographically determined myocardial asynchrony. Determination of asynchrony by Tissue Doppler echocardiography seems to be the best predictor for improvement after BVP, although no consensus on the optimal method to assess asynchrony has been achieved yet. Our own preliminary results show the usefulness of Tissue Doppler Imaging and Tissue Synchronization Imaging to document acute and sustained improvement after BVP. To date, all studies evaluating Tissue Doppler in BVP were performed retrospectively and no prospective studies with patient selection for BVP according to echocardiographic criteria of asynchrony were published yet. We believe that these new echocardiographic tools will help to prospectively select patients for BVP, help to guide implantation and to optimize device programming. © 2004 Knebel et al;licensee BioMed Central Ltd.

关键词： Echocardiography Biventricular pacing pacemaker programming patient selection

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Differentiated use of rate responsive pacing

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Herzschrittmachertherapie und Elektrophysiologie 2004年第2期15卷 177-187页

作者： Meine, Mathias Klin. fur Kardiologie und Angiologie Elisabeth-Krankenhaus Universität - GHS Essen 45138 Essen Moltkestraße 61 Germany

Rate responsive pacing is useful to restore the failing cardiocirculatory regulation in patients with chronotropic incompetence. The activity sensor is a non-physiological sensor. Its sensor signal correlates more with the form of exercise than with the work rate. Physiologically sensor controlled systems are using a physiological signal that is closely correlated to the metabolic demand. The sensors are divided into " open-loop" and "closed-loop" systems depending on the implementation of the sensor into the cardiac regulation. The activity and the minute ventilation sensors are "open-loop" systems which do not get any feedback from the heart rate. Sensors which measure the QT interval, the inotropy, and the dromotropy are "closed-loop" systems because they get a feedback from the heart rate. In dual sensor systems the "cross checking" and "sensor blending" are useful to optimize the rate response. The several properties of the sensor and its technical condition (the kind and position of the pacing leads) have to be taken into account before selection of the rate responsive pacemaker system. In modern pacemaker devices the holter and exercise testing functions are useful to optimise the rate responsive programming. Algorithms for the automatic optimisation of the sensor parameters may individually improve the rate responsive pacemaker therapy.

关键词： Chronotropic incompetence Closed-loop Open-loop pacemaker programming Rate responsive pacing Sensor control

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