E UROPACE
Results: Kappa 900 pacemakers have been implanted in 104 patients, with
55 complete measurements
from the l-month
visit available for comparison.
Data were excluded for one or more of the following
reasons: lead dislodgmerit (3), missing EGM to verify measurements
(X3), C M aborts due to fast
rhythms (13), and patient not having a l-month
visit prior to the trial cutoff
date (18). All leads were placed in the right ventricular
apex, and the following
characteristics
were represented: 50 bipolar including 45 long and 5 short ~14
mm) tip-ring spacing, 5 unipolar;
16 active and 39 passive; 13 low (520mV
POL), 39 medium/high,
and 3 unknown POL. On average, SD and C M voltage
T were 0.482 V and 0.486 V, respectively.
The average SD-CM T difference
of these tests was -0.005V with a 95% bootstrap coniidence interval (CI) upper
bound of 0.030 V The overall (2.sided) 95% CI for the average difference was
(-0.091,0.036).
No evoked response undersensing
was observed during either
24.hour Halter recordings from 11 patients or device memory analysis between
visits.
Conclusion: The ventricular C M T test showed reliable T results compared
to the manual SD T test when using a variety of ventricular
leads. In addition,
there was a 100% success rate of evoked response detection.
I
P 120
EFFECTIVENESS OF INTRACARDIAC
A TOOL TO OPTIMIZE A-V DELAY
IMPEDANCE
AS
A.P. Ravazzi, P. Diotallevi,
M.P. Provera, L. Brandolisio’,
C. Militelloz,
R. Audoglio3.
Div. of Cardiology
Osp. S. Antonio E Biagio, Alessandria,
Italy; ‘Biohvnik
Seda, Trezzano SIN, Italy; 2Biohvnik,
Erlangen,
Germany;
3Sra, Pavia, Italy
Introduction:
Programming
the optimal atriovenhicular
delay (OAVD) in pacemaker patients allows the completion
of the end-diastolic
filling flow prior to
ventricular
contraction providing the longest diastolic filling time. Non-invasive,
echocardiographic
assessment of OAVD is feasible, but time and resource consuming. Aim of this preliminary
study was to verify whether OAVD assessment
is feasible using informations
deducible
from right ventricular
intracardiac
impedance (Z) variations measured by the pacemaker INOS”
CLS (Biotronik,
Germany).
Methods: In 24 pts (16M; 67.5&11.5 yrs; 14 AVB, 10 SSS; NYHA I)
implanted with an INOS’+ CLS, the OAVD was assessed by Ritter’s formula
based on echo measurements.
At different programmed
AVDs, Z was measured
by the pacemaker and downloaded
via telemetry for post-processing.
Results: The OAVD assessed by echo highly correlated to that calculated on
the impedance when selecting the AV delay showing the highest value of the
maximum
of the squared 1” derivative (r=0.91, p<O.O05). Mean OAVD measured by echo and by Z were 162.0&25.7
ms and 160.4&26.4
ms respectively.
No statistical differences were observed between these values
Conclusion: Right ventricular intracardiac impedance seems to be a valid
tool for optimal AV delay assessment. Such an algorithm,
when implemented
in a pacemaker would significantly
improve patient hemodymmics
and reduce
follow-up
time.
I
P 121
F. Zolezzi,
Cardiology,
PERSISTENT CLOSED LOOP STIMULATION AND
HEART RATE VARIABILITY
IN NEUROMEDIATED
SYNCOPAL PATIENTS
R. Negro, C. Orvieni, L. Brandolisio’,
R. Audoglio’.
Div. of
Osp. Civile, Vigevano, Italy; * Biotronik-Seda,
Treuano SIN, Italy
Recent studies have shown that Closed Loop Stimulation
(CLS), modulated by
variations
in myocardial
contractility,
is effective in preventing
highly symptomatic,
neurally
mediated
syncopal
episodes whether
of cardio-inhibitory
vasovagal or of carotid sinus (CS) origin.
Aim of OUT study was to assess if a normal pattern of heart rate vatiability
(HRV) before and after implantation
of an INOS’+CLS
(Biotronik,
D) pacemaker is maintained.
The need of this investigation
was dictated by
the consideration
that CLS algorithm
requires a persistent (>85%)
ventricular
pacing to be effective, whereas these pts need to be paced in concomitance
of syncopal spell only. It was assumed that CLS maintains
an acceptable
HRV if difference between data collected before and after device implantation
are not statistically
signiiicative.Eighteen
consenting,
syncopal pts (15 m, age
68.3&13.6
yrs, mean 3.4 syncopeiyear),
with no evidence of atria1 or AV conduction diseases, were enrolled in the study. Syncope was reproducible
in all
pts, with positive response to HU’IT (Type 2A) in 6 pts, to CS massage (pause
> 5s) in 10 pts and to both in 2 pts. A 24-h ECG Halter and RR variability
analysis were performed before and after device implantation.
Mean HR, percentage of delta of R-R>50ms
(pNN50),
standard deviation
of averaged RR/5min (SDANN)
and standard deviation (SDNN) were analyzed
and compared.
The results, respectively before and after implantation,
were: HR 63.W12.7
vs. 69.6&10.2
bpm; pNN50 20.5&21.6
vs. 21.3&12.4%;
SDANN 138.4&58.9
2003
vs. 99.2&27.2
ms; SDNN 172.4&63.8
vs. 128.3&35.8
ms. Furthermore,
no
occurrences of syncopal spell were observed in these pts during a mean FU of
10.4 months. Data collected before and after implantation
are comparable and
differences
between groups are not statistically
signiiicative.
Therefore,
this
study confirms that Closed Loop Stimulation
is highly specific and effective
in the treatment of mummediated
syncope and preserves a physiologic
HRV,
despite a persistent ventricular
pacing.
I
P 122
RIGHT VENTRICULAR INLET SEPTAL PACING WITH
STEROID ELUTING TINED J-LEAD
Y. Shimoyama.
National
Tokyo Medical
Center
Introduction:
Although right ventricular pacing leads are traditionally
placed in
the apex, right ventricular
inlet septal (near His-bundle)
pacing is recommended
in order to obtain more physiological
pacing (in order to obtain minimal change
of the intravenhicular
conduction).
However, this septal pacing often appeared
high thresholds when screw-in leads were used. The very good results using
steroid eluting J shaped tined leads were obtained to pace right ventricular
inlet
Septulll
Patients and Methods: Fifteen patients were paced with steroid eluting
J-shaped tined leads (CapSure Z Novas: model 5554, Medrtonic,
Minneapolis,
MN, USA) in the right ventricular
inlet septum during DDD pacemaker implantation. Five patients were diagnosed sick sinus syndrome and ten were atria1
fibrillation
with bradycardia
Ventricular
sensing, pacing thresholds
(0.5 ms)
and lead impedance at 0.5ms-2.5V
were measured with ERA 300B (Biotronik,
Berlin, Germany) at implant and followed up.
Results: At implant, sensing amplitude were 5.6&3.7 mV, pacing thresholds
were l.O&O.S V and lead impedance were 766&150 ohms. Three postoperative
months (POM), mean sensing amplitude were 5.3&2.9 mV, pacing thresholds
(0.41~) were 1.3&1.2
V and lead impedance
(0.4ms-2.5V)
were 800&146
ohms. At 6 POM, those were 6.3&3.8 mV, 1.7&1.4 V, and 820&125
ohms. At
12 POM, those were 6.3&2.9 mV, 1.6&1.2 V, and 817&144
ohms.
Conclusion: Right ventricular
inlet septal pacing with J-shaped steroid
eluting tined leads revealed very good results.
I
P 123
TRICUSPID REGURGITATION
PERMANENT PACEMAKER
M. Yahalom, M. Gellerman,
Galilee Hospital, Nahariya,
IN PATIENTS WITH
N. Roguin. Department
of Cardiology, Western
Faculty of Medicine,
Technion, Haifa, Israel
Introduction:
The prevalence of Tricuspid Regurgitation
(TR) in patients (pts)
Pacemaker (PP) is still controversial.
Objectives: The aims of the study were to investigate tricuspid regurgitation (TR) in patients (pts) with Permanent Pacemaker (PP) and it’s severity
and association with Mitral and Aortic valve disease and with decreased LV
function.
Materials and Methods: Eighty one consecutive pts, who attended the
pacemaker clinic during the second half of the year 2001 [46 males and 34
females, mean age 74.5 year (range 21.94)] were studied. All 81 pts were
examined by two-dimentional
and Doppler Echocardiography
(2 months to 10
years following
PP implantation).
Results: The amount of TR was judged as normal or trivial in 28(35%),
mild in 35(43%), moderate in 14(17%), and severe in 4(5%). Out of 22 pts with
Mitral valve disease, 14(64%) had moderate/severe
TR. In 59 pts with “normal
flow” Mitral valve only 4(7%) had moderate/severe
TR @<O.OOl). In 7(58%)
out of 12 pts with severely decreased LV function there was moderate/severe
TR. In 69 patients with EF>35%,
moderate/severe
TR was seen in 11(16%),
@<0.004).
Aortic Valve (Av) d’wax
was found in 11 pts: 4128 (14%) with
trivial TR, 4135 (11%) with mild TR, 3114 (21%) with moderate TR. None of
the severe TR pts had AV disease (p=ns).
Conclusions: The severity of TR in pts with PP is signiiicantly
correlated
with Mitral valve disease and with decreased LV function, not with Aortic valve
disease and perhaps not with the implantation
per-se.
with Permanent
I
P 124
ELECTRICAL AND HANDLING CHARACTERISTICS
OF
A N E W DOWNSIZED PASSIVE FIXATION PACING LEAD
A. Schuchert, E. Stammwitz,
B. Now&
I. Rows, D. Schmitz, N. Doll. For
The Is&x
S European Evaluation
Group; UKe Hamburg
Germany,
Kreiskrankenhaus
Leer Germany, Ccb Frankjirt
Germany, University of Tartu
Estonia, St. Johannes Dortmund
Germany,Heruenhwn
Leipzig Germany)
Purpose: This study evaluated
the performance
of the new St. Jude Medical
IsoFlex S lead family. These silicone leads feature a reduced lead body diameter,
which is coated with Fast-Passm to improve handling. The atria1 “.I” version of
the lead has a bipolar tip-ring spacing of 10 mm, the straight version 12 mm.
Europace Supplements,
Vol. 4, December 2003
B95