E UROPACE
(II), QT-d as a difference between QT maximum and QT minimum, corrected
QT (QTc), corrected QTd (QTdc), QT peak and T wave peak-to-end (Tp-Te)
in lead V5.
Results: At the end of the follow-up we observed a significant decrease
mean systolic blood pressure from 157&9 to 138&10 m m H g and mean diastolic
from 98&4 to 86&7 mmHg.
QTcOl)
QT@)
Baseline
12 weeks
P
384+36
3s4*33
NS
411+31
411+35
NS
QT-d
QT-dc
QTpeak(V5)
Tp-Te(V5)
40+17
32+13
<O.OOl
43+1a
34+13
<O.OOl
311+34
308+32
NS
82+14
77+14
<O.OOl
mean value * SD in ms.
The pattern of repolatiation
parameters was similar in patients who achieve
the target BP and in remaining pts.
Conclusions: The combination therapy with low dose of ACE-inhibitor and
diuretic significantly decreased QT-d and T wave peak-to-end value which are
well known markers of spatial and trammural dispersion of repolatiation.
I P 458
ELEVATION OF CARDIAC TROPONIN AFTER
SUSTAINED TACHYCARDIA IS A FREQUENT FINDING
IN PATIENTS WITHOUT EVIDENCE OF ACUTE
CORONARY DISEASE
.I. Carlsson, .I. Brockmeier, A. Cuneo, U. Tebbe. Medizinische
Klinihm
Lippe,
Detmold,
Klinik
Age
ECG, and depressed left ventricular ejection fraction (LVEF<0.40) at echocardiographic evaluation. EPS was performed in 47 of 67 (70%) eligible patients
(mean age 58&7 years, male gender 89%, anterior myocardial infarction 66%,
thrombolysis treatment 41%, LVEF < 0.40 77%, presence of ventricular late
potentials 68%, Lawn 4A-B 70%) and was considered positive when sustained
monomorphic VT was induced. During a follow-up of 9.5&2.8 years, we
observed 12 cardiac deaths (27%, sudden death in 3 cases) and 7 non cardiac
deaths (16%); 5 deaths for unknown causes (11%) also occurred, 3 (6%) patients were lost at follow-up, non fatal sustained ventricular tachymhythmias
occurred in 7 pts (16%). The analysis was performed in 39 patients with known
cause of death. At univariate analysis we found that inducibility of sustained
monomorphic VT was signiiicantly different among patients with and without
cardiac death as in patients with and without arhythmic events (67% vs 26%, p
= 0.02; 90% vs 24%, p = 0.001).
CAD
Chestpain
I P 460
II,
Type of T
Duration
of T (hrs)
1 VT, 2 TM., 5 AVNRT,
1 AVRT, 1 PMT
3 TM., 1 AVRT, 5 AVNRT
9+7
during T
(Y-N
Tnl 3 0.5 n&,1
10 50+12
l/l0 (10%) 6110 (60%)
Tnl < 0.5 ngiml
9 54+14
119 (11%)
519 (55%)
3*3
Sustained tachycardia leading to a TnI elevation is a frequent finding in
the absence of acute coronary disease and other conditions known to induce
myocardial cell necrosis with subsequent tmponin rise. The duration of the
tachycardia seems to be related to the extent of myocardial injury. Since chest
pain during tachycardia despite nonml coronary arteries is a common complaint, risk stratiiication is likely to be difficult in these patients with an elevated
troponin level after sustained tachycardias.
P 4%
LONG TERM PROGNOSTIC VALUE OF
ELECTROPHYSIOLOGIC
STUDY AFTER MYOCARDIAL
INFARCTION: A TEN YEAR FOLLOW-UP STUDY
S. Sarzi Braga, R. Vaninetti, R.F.E. Pedretti. Cardiology
Fondazione
S. Maugeri
Istituto
Scientijico
I.R.C.C.S.
Di Tradate
The long-tern prognostic power of inducible sustained ventricular tachycardia
(VTJ at an electmphysiologic study (EPS) p erf onned 1 month after a myocardial
infarction (MI) is still unknown. In order to evaluate the long-tern prognostic
value of inducible sustained VT after MI, we investigated the clinical outcome
of a group of patients who underwent an EPS because of abnormal noninvasive
testing. Of 305 consecutive patients admitted to OUTinstitution after myocardial
infarction, 67 (22%) were eligible for EPS because of the presence of ? 2 of
the following noninvasive risk markers: Lawn 4A-B ventricular arrhythmias
at Halter monitoring, presence of ventricular late potentials at signal-averaged
B174
Europace Supplements,
Vol. 4, December 2003
Cox regression
analysis
only
BRAIN (B-TYPE) NATRIURETIC PEFTIDE (BNP) ON
EARLY POST MYOCARDIAL
INFARCTION PERIOD:
PROGNOSTIC INDEX OF EARLY MAJOR POST
MYOCARDIAL
INFARCTION RELATED ARRHYTHMIAS
D. Simeonidou, Otsalos Otsaridis, Sichlimiris Arouos, G. Tsigas,
D. Alexopoulos, S. Anolis. Cardiology Department,
C. Georgiopoulou,
University Hospital,
Pahm
Greece
Introduction: It is well known that acute myocardial infarction (AMI) induces
neurohomonal activation resulting in elevation of plasma levels of ventricular
natriuretic peptide (BNP). So far there are no data connecting this BNP elevation with the development of major arrhythmias, such as atria1 fibrillation
(AF), sustained monomorphic ventricular tachycardia (SMVT), polymorphic
VT (PVTJ or ventricular fibrillation (VF) in the early post-MI period.
Methods: The study population consisted of 20 patients, 17 men and 3
women mean age 61&13 years, who were admitted with a diagnosis of AMI.
The levels of plasma BNP at 24 hours after admission were measured and
related to the development or not of major arrhythmia events during hospitalization and during the first month post-AMI. W e also compared BNP levels
with the location of AMI, the mode of reperfusion, peak CPK and left ventricular ejection fraction. The patients who survived the early post-MI period
were followed up initially for 1 month and underwent Halter monitoring for
exclusion of major arrhythmias.
Results: Measured levels of BNP ranged between 53 and 1036 pgiml, mean
395&310 pgiml. During the acute phase, 2 patients developed AF, 2 significant
bradycardia, 1 junctional rhythm, and 1 PVT. During their hospital stay, 1
patient developed VT and VF, 1 patient VF and 1 patient 3 episodes of PVT.
During the first month of follow-up, 2 patients from the group with the highest
BNP values died of non-sudden cardiac death. There was no relation between
the BNP level and the development of serious arrhythmias during the acute
phase or the early predischarge phase. However, there was a correlation between
arrhythmia development from the 2”d post-AM1 day until the discharge time.
Conclusion: Assessment of BNP within 24 hours post-AM1 is a reliable risk
stratiiication
index for development of serious arrhythmias prior to discharge.
It appears that a BNP increase during this period does not predict serious arrhythm& during the first month post-AMI. A larger patient cohort and longer
duration of follow up are needed to validate or refute these preliminary results.
I
I
At multivariate
LVEF mmteined a significant prognostic power. No significant relationship was
found between EPS result and all cause mortality. In conclusion, we report that
inducible sustained monomorphic VT 1 month after a MI can suggest a poor
cardiac prognosis in patients with high arhythmic non-invasive risk profile, but
in long-term follow-up only LVEF may be considered a significant predictor of
adverse outcome.
Germany
Elevations of troponins T and I (TnT and TnI) reflect irreversible myocardial
cell necrosis. This usually occurs in acute coronary artery disease (myocardial
infarction with or without ST-segment elevation). However, abnormal values
have been described in various conditions not related to infarction, like pulmonary embolism, acute heart failure, myocarditis, septic shock, and after
therapeutic procedures like electrical cardioversion or ablation. W e describe the
elevation of TnI after sustained tachycardias (T) which has to OUTknowledge
not been reported before.
In 19 patients (table) who presented to the emergency department with
various types of sustained T. TnI was measured (Abbott Axsym, Illinois, USA).
None of the patients had any ECG evidence of an acute coronary event and none
had a significant elevation of CKICK-MB. None had any evidence of reduced
renal function. The following types of T (rate 130-190 beats per min.) were
encountered: ventricular T (VT), AV-node-reentry T (AVNRT), AV-reentry T
(AVRT), tachyarrhythmia with atrial fibrillation or atria1flutter (TAA), and pacemaker mediated T (PMT). The maximum TnI values during the clinical course
ranged between 2.7 and 11.5 ngiml. All patients with TnI elevation and 519 of
those without underwent coronary angiography. The only significant difference
between patients with and without a rise of TnI was the duration of the T.
n
2003
P 461
SAECG: TIME-, FREQUENCY- AND COMBINED
ANALYSIS IN A HIGH RISK GROUP
F. Schnoll, M. Landschutzer, B. Kogler, G. Dreyer, A. Gassner. Rz
Grossgmain
Der Pva, Grossgmain,
Awhia
Introduction: SAECG has been extensively studied as risk parameter for significant ventricular arrhythmias post MI in low risk populations. Its value in
patients with high pretest risk remains to be defined but would be of substantial interest to select individuals for intervention. Recently a combined index
using time-domain analysis (TD) and the frequency-domain analysis spectral
turbulence (ST) has been proposed to increase the predictive value (Vazquez
JACC 1999).
Methods: 45 patients (age 63&9,91% male, all with CHD, LV-EF 35&12%)
had SAECG recorded with noise-level < 0,7 FV using the ART 1200 EPX
(Arrhythmia Research Technology, Austin, Texas) and analysed in TD, spectrotemporal mapping (STM), ST and a combined index of TD and ST. Programmed ventricular stimulation for spontaneous sustained VT, syncope or
E UROPACE
MADIT-I
criteria was performed using 2 basic drives, 2 locations and up to 3
extrasystoles. Induction of sustained VT was diagnosed if it was sustained for
at least 30 seconds or had to be terminated earlier because of hemodynmic
compromise.
Results: Sustained VT was induced in 51% (23145).
analysable
sensitivity
specikity
PP”
“P”
accnracy
TD
STM
ST
73% (33145)
50% (8116)
68% (13119)
57% (8114)
62% (13121)
60% (21135)
100% (45145)
22% (5123)
91% (ZO/ZZ)
71% (517)
53% (20138)
56% (25145)
100% (455w)
83% (19123)
59% (13122)
68% (19128)
78% (13117)
71% (32145)
TD+ST
100% (455145)
52% (12123)
82% (18122)
75% (12116)
62% (18129)
67% (30W)
Conclusion: Prediction of inducibility of sustained VT in this high-risk
population was best achieved with ST. TD could be analysed in less than 314 of
patients with lower predictive value, the very low sensitivity of STM precludes
its clinical use. The combination of TD and ST did not perform better than ST
alone.
I P 462
A N E W DUAL-CHAMBER
VENTRICULAR
PACING
PACING MODE TO PREVENT
A. Savoure’, F. Anselme’, D. Galleyz, P. Defaye3, S. Reuter4, Frohlig5,
P.H. Mabo6, N. Sadou17,A. Amblard’, G. David’. University Hospit&
‘Roueg
2All@ 3Grenoble, “Bordeaux,
6Rennes, 7Nancy, France;
5Medizinische
lJniversitatsklinik
III, Homburg,
Germany; ‘Ela Medical,
Plessis-Robinson,
France
P 463
INFLUENCE OF INTRAVENOUS THEOPHYLLINE
ADMINISTRATION
ON SINUS NODE FUNCTION
Institute of Cardiology
John Paul II Hospital,
University, Cracow, Poland
Medical
Extrinsic
Group 1
Mean
SD
Mean
SD
Group 11
School
of
Background: The TEOPACE study, performed in patients with sick sinus
syndrome, revealed the clinical improvement after orally administered theophylline.
The aim of study: Evaluation of sinus node automaticity (SNA) after theophylline administration in patients with sinus node dysfunction (SND)
Study population: W e observed 102 pts (27 women, 75 men) aged 38-71
yrs, with history of syncope and/or symptomatic bradycardia. Other, than SND,
reasons of syncope were excluded by: EEG, head-up tilt-test and 24.hour Halter
ECG.
Methods: All pts underwent transoesophagealrapid atria1 stimulation (RAS)
for evaluation of extrinsic and intrinsic sinus node recovery times (SNRT) and
corrected sinus node recovery times (CNRT). Pharmacological blockade (PHB)
of sinus node was done with iv proprmolol and atmpine administration. After
evaluating of intrinsic SNRT, CNRT, iv injection of 250 m g theophylline was
done and rapid atria1 stimulation was conducted. Extrinsic, intrinsic and posttheophyllin SNRT, CNRT were compared. SNRT > 1500 ms and CNRT > 525
ms were assumed as abnormal. Based on values of extrinsic and intrinsic sinus
Intrinsic
After iv. theophylline
SNRT
CNRT
SNRT
CNRT
SNRT
CNRT
1688,80
678,85
1254,16
115,82
722,lO
643,35
427,78
64,27
1731,30
1415,96
1053,16
100,70
876,SO
1343,32
351,22
72,69
1737,26
1522,61
1052,31
125,58
872,27
1442,77
362,44
89,13
There were significant differences between sinus node recovery times measured in both groups (p<O,OOl)
Conclusions: 1. Theophylline increased intrinsic heart rate both in patients
with and without sick sinus syndrome. 2. Theophylline did not influence significantly on intrinsic sinus node recovery times in patients with and without sick
sinus syndrome. 3. Clinical improve after Theophylline administration in SSS
pts. is probably related to their positive chronotropic influence on sinus node.
464
EFFECT OF NITROGLYCERIN
ADMINISTRATION
ON
SINUS RHYTHM IN PATIENTS WITH SINUS NODE
DYSFUNCTION
A.Z. Pietmcha, W. Piwowmka. Coronary Disease Department,
Cardiology
John Paul II Hospital,
Cracow, Poland
Medical
School
of Jagiellonian
Institute of
University
The aim of study was evaluation of nitroglycerine (NTG) iv b&s influence on
sinus rhythm frequency in pts with sinus node dysfunction (SND).
W e observed 102 pts (27 women, 75 men) aged 38-71 yrs, with suspected
sinus node dysfunction. Based on results of rapid atria1 stimulation before and
after pharmacological blockade with propranolol and atropine (PB) all pts were
divided into 4 groups: group I - 32 pts without electrophysiological signs of
SND, Group II - 23 pts. with only decreased intrinsic heart rate (IHR), group
III - 19 pts. with functional SND and group IV - 28 pts with organic SND.
All pts showed sinus rhythm in standard ECG. After PB rapid injection of 100
mcg NTG was done in all pts. Maximal HR (HR&
and HR measured after
NTG bolus (HR5& were measured. Maximal HR increase (AHR,,,& and HR
5 minutes increase (AHR5& after NTG a d ministration and relative values of
these parameters (AHR% max, AHRs,&
were calculated. All measured and
calculated parameters were compared between groups.
Results:
Table 1. Heart rates before and after nitroelvcerine administration
Group
HRO
[Urnin]
1
St,94
72,70
73,42
69.60
”
“1
1”
A.Z. Pietmcha, D. Mroczek-Czemecka, W. Piwowmka. Coronary Disease
Department,
Jagiellonian
node recovery times all pts were divided into two groups: group I - 70 pts with
SSS and group II - 32 pts without electrophysiological signs of SSS.
Results: Mean HR was lower in pts from group I (60,31 vs. 69,25 bpm,
p<O,OOl). IHR was also lower in group I (72,14 vs 86,41 bpm, p<O,OOOl).
IHR after theophylline administration increase signiiicantly in both groups (gr.1
76,39 vs 72,14 bpm, p<O,Ol; gr.1190,94 vs. 86,41 bpm, p<O,Ol). HR increase
after theophylline was similar in both groups (5,54 vs. 5,59 bpm, p=O,95).
Values of sinus node recovery times are included in the table.
IP
Le
Despite a low annual incidence of high degree AV block in patients with sick
sinus syndrome, programming of AA1 mode remains coniidential in this pacing
indication. Besides, a recent atria1 arrhythmia prevention study pointed out a
potential negative impact of ventricular pacing on AF burden. A newer pacing
mode was therefore designed in order to combine the advantages of AA1 mode
with the safety of a DDD device.
Methods: The AAIsafeR mode behaves like an AA1 mode (no AV delay
triggered on atria1 events) when no AV block is diagnosed. AV block I and II are
tolerated up to a predetermined level, and a DDD conversion is provided in case
of high degree AV block. While functioning in DDD, the device periodically
intents to switch back to AAI, if spontaneous AV conduction recovered.
The safety of this new pacing mode has been evaluated on 18 patients (12
males, age 72&12 years) implanted with a Symphony DR 2550 dual chamber
pacemaker (ELA Medical, France). Indications were sinus node dysfunction
or paroxismal AV block with a PR<250 ms. All patients underwent a 24.hour
Halter recording with the AAIsafeR mode activated.
Results: No adverse event related to the new pacing mode has been reported.
In 3118 patients, the device switched appropriately to DDD due to occurrence
of high degree AV block. In 15118 patients, no AV block was observed during
the 24.hour record leading to a ventricular pacing percentage ~1%.
Conclusions: AAIsafeR mode is safe, preserving ventricular activity in case
of paroxysmal AV block while maintaining a very low ventricular pacing ratio.
An international randomized study will assess the efficacy of this new pacing
mode in the specific application of AF prevention.
I
2003
HR,,
[limin]
92,25
SO,81
81,00
76.29
HRsm
[limin]
AHRmx
[Urnin]
87,75
75,88
76,00
72.21
7,31
7,32
7,58
6.93
AH&n,
[limin]
2,81
3,20
2,58
2.93
AHRY, mai
AHRY, imm
[%I
[%I
8,46
lo,42
10,47
9.86
3,24
4,63
3,56
4.09
Both: HR,, and HRsmln were signiiicantly higher than HRo in all groups
of pts. (p<O,OOOl; tablel). The value of HR increase parameters: AHR,,,
AHR5mm AH% max, AHR%,mn did not differ signiiicantly between studied
groups of pts.
Conclusions: 1. Nitroglycerine, as NO donor, increased frequency of sinus
rhythm. 2. Increase of sinus rhythm frequency after nitroglycerine administration did not depend on the mechanism of sinus node dysfunction.
IP
465
THE DATA OF LONG-TERM FOLLOW-UP OF THE
PATIENTS WITH SICK SINUS SYNDROME
N. Burma, G. Golubeva, I. Vorobiev. Research Institute
St.Petersburg,
of Cardiology,
Russia
The aim of the study was to determine the peculiarities of the clinical course,
prognosis, and outcome of the patients with sick sinus syndrome (SSS).
Methods: 203 patients with SSS (83 men,mem age 77,8&X3,3) were followed from 3 to 10 years; 118 ones had the paroxysmal atria1 fibrillation (AF)
- SSS-1 and, in 85 patients, the paroxysmal AF was not revealed - SSS-2.
At the moment of the follow-up onset, the pacemaker implantation was not
indicated. The dynamics of complains and the patients state, the quality of life
Europace Supplements,
Vol. 4, December 2003
B175