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Preventive pacing in patients with paroxysmal atrial fibrillation: programming and follow-up of patients with dual-chamber pacemakers and triggered preventive pacing functions

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Herzschrittmachertherapie und Elektrophysiologie 2002年第1期13卷 20-29页

作者： Schuchert, A. Meinertz, T. Medizinische Klinik Abteilung für Kardiologie Universitätsklinikum Hamburg-Eppendorf 20246 Hamburg Martinistr. 52 Germany

A treatment of patients with paroxysmal atrial fibrillation is the implantation of DDDRP pacemakers for preventive pacing. Atrial pacing with the aim for preventive pacing of atrial fibrillation can be classified as continuous constant pacing with a fixed manually programmed lower atrial pacing rate. The second approach is continuous dynamic overdrive pacing realized by new pacing algorithms, e. g., Pace Conditioning in the Vitatron DDDRP pacemakers. The third approach is discontinuous triggered pacing when specific pacing algorithms are activated by trigger events and temporally pace the atrium. The actual established indications for preventive pacing are patients with a conventional pacing indication and a history of paroxysmal atrial fibrillation. A possible indication are patients with a standard indication for cardiac pacing and a high risk to develop atrial fibrillation as well as patients with drug-refractory atrial fibrillation before AV-node ablation. After pacemaker implantation the pacemaker can be programmed individually according to the onsets of atrial fibrillation observed in the patient or the patient receives a standard programming and subsequently an individual adjustment of the pacing functions. The success of preventive pacing should be assessed a each follow-up visit by interrogation of the extended diagnostic pacemaker counters. There are at present no prospective studies concerning the effects of different pacemaker programming.

关键词： Antiarrhythmic drugs Atrial fibrillation Dual-chamber pacemaker pacemaker programming Preventive pacing

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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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FOLLOW-UP OF DDD pacemakerS

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PACE-PACING AND CLINICAL ELECTROPHYSIOLOGY 1984年第6期7卷 1187-1194页

作者： LUCERI, RM HAYES, DL MAYO CLIN & MAYO FDN DIV CARDIOVASC DIS & INTERNAL MED200 1ST ST SWROCHESTERMN 55905 UNIV MIAMI JACKSON MEM MED CTRDIV CARDIOLMIAMIFL 33152

La surveillance des pacemakers DDD est devenue de plus en plus difficile à cause de la complexitSeA croissante des générateurs d'impulsion. Un “test type” devrait être développé pour permettre une analyse systematique et l'enrégistrement des données. Pour suivre efficacement un patient porteur d'un pacemaker DDD il est nécessaire de connaître son rythme sousjacent celeri du générateur d'impulsion, la souplesse de sa programmation et ses autres

关键词： physiologic pacemakers pacemaker follow‐up pacemaker programming pacemakers

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STABILITY OF PACING THRESHOLD, IMPEDANCE, AND R-WAVE AMPLITUDE AT REST AND DURING EXERCISE

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PACE-PACING AND CLINICAL ELECTROPHYSIOLOGY 1990年第12期13卷 1602-1608页

作者： SCHUCHERT, A KUCK, KH BLEIFELD, W The Medical Clinic Department of Cardiology University Hospital Eppendorf Hamburg Federal Republic of Germany

The pacing threshold of the human heart may be altered by physiological factors such as physical exercise. These changes may influence the individual programming of a pacemaker, since pacemakers can be programmed at pulse amplitudes of 2.5 volts and less. We investigated 22 patients with a multiprogrammable ventricular demand pacemaker 3 months after implantation;16 patients had received a steroid-eluting lead and six patients had an Elgiloy lead. Parameters measured at rest and immediately after exercise were: Voltage threshold at pulse durations between 0.05 and 0.6 ms, impedance, R wave amplitude and energy consumption for the pacing threshold at 0.5 ms pulse duration. All patients performed a symptom limited supine bicycle exercise test. None of investigated parameters showed a significant difference between rest and exercise, neither for the steroid eluting lead nor for the Elgiloy lead. The data suggest that the individual programming of a pacemaker adapted to the measurements at rest is also reliable and safe during exercise.

关键词： pacemaker programming EXERCISE TESTING PACING THRESHOLD IMPEDANCE R-WAVE AMPLITUDE STEROID-ELUTING LEAD

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Heart rate distribution in dogs with third degree atrioventricular block and rate responsive pacemakers

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JOURNAL OF VETERINARY CARDIOLOGY 2022年第0期43卷 70-80页

作者： Pires, A. Raheb, S. Monteith, G. Colpitts, M. E. Chong, A. O'Sullivan, M. L. Fonfara, S. Univ Guelph Dept Clin Studies Ontario Vet Coll 50 Stone Rd East Guelph ON N1G 2W1 Canada Univ Prince Edward Isl Dept Compan Anim Atlantic Vet Coll 550 Univ Ave Charlottetown PE C1A 4P3 Canada Toronto Vet Emergency Hosp 21 Rolark Dr Scarborough ON M1R 3B1 Canada

Introduction: In dogs, single lead ventricular pacing, ventricular sensing, inhibition response, rate adaptive (VVIR) pacemakers are routinely used to treat third degree atrioventricular block (3AVB). The objectives of this study were to investigate the heart rate distribution in dogs with VVIR pacemakers, and report changes when activity settings were adjusted. Animals: Eighteen client-owned dogs with VVIR pacemakers for 3AVB. Materials and methods: This observational study consisted of a review of medical records of dogs with VVIR pacemakers. For dogs with >50% of paced beats at the lower pacing rate the activity daily living (ADL) and exertion responses were in-creased. Re-evaluations were performed after 6-12 months. Results: Heart rate distribution similar to healthy dogs was absent for all dogs. In nine dogs the ADL and exertion responses were increased to the highest level. Of these, three dogs showed no improvement in heart rate distribution;for two dogs, one with an epicardial pacemaker, several activity settings were adjusted and pacing at higher heart rates was observed at re-evaluation. Four dogs died or were lost to follow-up. Clinical signs had resolved for all dogs after pacemaker implantation. Conclusion: Default activity settings of VVIR pacemakers do not result in heart rate distribution equivalent to healthy dogs. Increasing the ADL and exertion response set-tings to the highest levels did not improve the pacemaker rate response. Further in-vestigations into the role of dog size, generator positioning, pacemaker settings, and whether rate responsiveness is required for dogs's quality and quantity of life, are warranted. (C) 2022 Elsevier B.V. All rights reserved.

关键词： Bradyarrhythmia Canine Exercise pacemaker programming VVIR

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Clinical experience of a new rate drop response algorithm in the treatment of vasovagal and carotid sinus syncope

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EUROPACE 2000年第3期2卷 245-250页

作者： Johansen, JB Bexton, RS Simonsen, EH Markowitz, T Erickson, MK Odense Univ Hosp Dept Cardiol DK-5000 Odense C Denmark Freeman Rd Hosp Reg Cardiothorac Ctr Dept Cardiol Newcastle Upon Tyne NE7 7DN Tyne & Wear England Medtron Inc Cardiac Rhythm Management Minneapolis MN USA

Dual chamber pacing has proven beneficial in patients with sudden drops in heart rate as seen in vasovagal syncope and carotid sinus syndrome. Newer algorithms for faster detection of an insidious drop in heart rate and short lasting intervention pacing at a high rate, as in the rate drop response algorithm in the Medtronic Kappa series of pacemakers, might improve the effect of pacing. Two case reports, that demonstrate the use of these rate crop response algorithms, are presented. A 24-year-old woman with recurrent episodes of syncope and repeated tilt-table tests with vasovagal cardioinhibitory outcomes had a Medtronic Kappa 400 pacemaker implanted. Syncope was abolished during repeat tilt-table testing following pacemaker implantation and proper functioning of the rate drop response algorithm. The patient has been free of syncope during follow-up apart from a single episode that occurred due to neglect of vasovagal warning symptoms. A 52-year-old man with coronary artery disease developed recurrent blackouts. Carotid sinus massage resulted in 5.5 s of asystole and presyncope. A Medtronic Kappa 700 pacemaker with a rate drop response algorithm was implanted and the patient became asymptomatic. The rate drop response algorithm is discussed in detail based upon the case reports, and recommendations are given for the use of this algorithm in patients with vasovagal syncope and carotid sinus syndrome. (Europace 2000;2: 245-250) (C) 2000 The European Society of Cardiology.

关键词： neurocardiogenic syncope vasovagal syncope carotid sinus syncope dual chamber pacing pacemaker programming rate drop response algorithm

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Electrical abnormalities with St. Jude/Abbott pacing leads: A systematic review and meta-analysis

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HEART RHYTHM 2021年第12期18卷 2061-2069页

作者： Khatiwala, Roshni V. Mullins, Elizabeth Fan, Dali Srivatsa, Uma N. Dhruva, Sanket S. Oesterle, Adam Univ Calif Davis Dept Internal Med Sacramento CA 95817 USA Univ Calif Davis Dept Internal Med Div Cardiol Sacramento CA 95817 USA Univ Calif San Francisco San Francisco Vet Affairs Med Ctr Dept Internal Med Div Cardiol 4150 Clement StBldg 203Room 2A-25 San Francisco CA 94121 USA

BACKGROUND Although there is a paucity of contemporary data on pacemaker lead survival rates, small studies suggest that some leads may have higher malfunction rates than do others. OBJECTIVE The purpose of this study was to determine the malfunction rates of current pacemaker leads. METHODS A meta-analysis including studies that examined the non-implant-related lead malfunction rates of current commercially available active fixation pacemaker leads was performed. An electronic search of MEDLINE/PubMed, Scopus, and Embase was performed. DerSimonian and Laird random effects models were used. RESULTS Eight studies with a total of 14,579 leads were included. Abbott accounted for 10,838 (74%), Medtronic 2510 (17%), Boston Scientific 849 (6%), and MicroPort 382 (3%) leads. The weighted mean follow-up period was 3.6 years. Lead abnormalities occurred in 5.0% of all leads, 6.1% of Abbott leads, 1.1% of Medtronic, 1.4% of Boston Scientific, and 5.5% of MicroPort. The most common lead abnormality was lead noise with normal impedance. Abbott leads were associated with an increased risk of abnormalities (relative risk [RR] 7.81;95% confidence interval [CI] 3.21-19.04), reprogramming (RR 7.95;95% CI 3.55-17.82), and lead revision or extraction (RR 8.91;95% CI 3.36-23.60). Abbott leads connected to an Abbott generator had the highest abnormality rate (8.0%) followed by Abbott leads connected to a non-Abbott generator (4.7%) and non-Abbott leads connected to an Abbott generator (0.4%). CONCLUSIONS Abbott leads are associated with an increased risk of abnormalities compared with leads of other manufacturers, primarily manifesting as lead noise with normal impedance, and are associated with an increased risk of lead reprogramming and lead revision or extraction.

关键词： Lead malfunction Lead noise Lead extraction pacemaker lead pacemaker programming

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USEFULNESS AND ADEQUACY OF SENSOR DATA-STORAGE AND RETRIEVAL FOR RATE RESPONSE SIMULATION

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PACE-PACING AND CLINICAL ELECTROPHYSIOLOGY 1992年第11期15卷 1688-1695页

作者： MAHAUX, V WALEFFE, A KULBERTUS, H Department of Cardiology University Hospital Sart Tilman Liege Belgium

The usefulness of sensor data storage for rate response simulation was evaluated using a new dual chamber rate modulated pacemaker sensitive to acceleration forces (Relay 294-03 [Intermedics Inc.]). The pacemaker can store the sensor output during routine exercise and those values can be used to simulate rate profiles for other rate response settings. The predictive value of this feature was evaluated in three studies (mechanical, external pacemaker, and implanted pacemaker). In the first study, the pacemaker was submitted to three runs of eight different mechanical calibrated to-and-fro movements. In the second study, nine external pacemakers were strapped on healthy volunteers who performed three jogging tests. Finally, the predictive value of the simulation was studied in five implanted patients during three successive walking tests. In each study, the pacemaker was submitted three times to the same activity. The responsiveness was successively set to 5, 1, and 10, and the pacemaker outputs were continuously recorded on a Holter monitor. At the end of the first run, rate profile simulations for slopes 1 and 10 were performed;slope 5 rate response was simulated after the second run. A regression analysis was used to establish the correlation between predicted and achieved pacing rates for each study. The coefficients of correlation between predicted and measured pacing rates for the mechanical, external, and clinical studies were 0.999, 0.985, and 0.823, respectively. The corresponding slopes of regression lines were 1.005, 0.971, and 0.935. Calculated rate profile has a high predictive value and could be used to optimize rate responsive settings without serial exercise testings.

关键词： RATE ADAPTIVE PACING HOLTER MONITORING pacemaker programming

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Electrocardiographic interpretation of pacemaker algorithms enabling minimal ventricular pacing

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HEART RHYTHM 2020年第10期17卷 1784-1792页

作者： Mond, Harry G. Univ Melbourne Royal Melbourne Hosp Dept Cardiol Parkville Vic Australia CardioScan Pty Ltd Camberwell Vic Australia

Cardiac pacing from the apex of the right ventricle has been shown to result in left ventricular dysfunction, atrial fibrillation, and increased mortality. To counter these effects, one of the strategies developed is avoidance of ventricular pacing when not necessary, using programmable algorithms to minimize ventricular pacing. Seven algorithms are available from 5 manufacturers. Four of the manufacturers have mode conversion algorithms that pace AAI(R) but, in the presence of failed atrioventricular (AV) conduction, demonstrate algorithm-offset and convert to DDD(R) with ventricular pacing. Three manufacturers do not have mode conversion but rather AV extension to encourage AV conduction. Each of these algorithms has a unique design and, when ventricular pacing is present, will regularly schedule conduction testing to encourage AV conduction and hence algorithm-onset. All of these algorithms seem to violate the rule of AV conduction by allowing the AV delay for sensed ventricular events to be longer than for ventricular paced events. The result is frequently bizarre electrocardiographic (ECG) appearances that often are unique to the company's algorithm but also suggest pacemaker malfunction. This review highlights and illustrates the features of these algorithms as they appear on ECG, and discusses other situations that result in unintended ventricular pacing.

关键词： Atrioventricular delay Cardiac failure Electrocardiography Minimize ventricular pacing pacemaker algorithms pacemaker programming

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COMPUTER-SIMULATION OF CARDIAC PACING

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PACE-PACING AND CLINICAL ELECTROPHYSIOLOGY 1988年第2期11卷 174-184页

作者： AHLFELDT, H TANAKA, H NYGARDS, ME FURUKAWA, T WIGERTZ, O UNIV TOKYO INST MED ELECTRTOKYO 113JAPAN

A mathematical model of the cardiac conduction system, including external pacemakers, has been developed. The heart is modeled as a network in which the impulse propagation is described by differential equations; several arrhythmia-generating mechanisms, such as modulated parasystole, reflection, macro and micro re-entry and block, can be simulated. Different kinds of pacemaker modes have been incorporated in the model, thus making it possible to simulate the interaction between the heart and the pacemaker. The model can be tuned by the user according to electrophysiological data so that pacemaker programs can be tested under different underlying conditions. During a simulation, the program generates ECG signals and pacemaker diagnostic diagrams. This model can be used for training and testing, and also as a support system when searching for the optimal pacing therapy for a particular patient.

关键词： cardiac simulation dual chamber pacing pacemaker programming

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