Jacob H Ruiter, Elles Mulder, Andreas Schuchert, Haran Burri, Markus C Stühlinger, Juha Hartikainen, Sergio Sermasi, Jitka Vlasínová, Georges H Mairesse, Eberhard Bub, Thorsten Lewalter[show abstract] [hide abstract]
ABSTRACT: Modern pacemakers continuously store significant cardiac-related events. Interpreting these data and reprogramming the pacemaker can be time-consuming and demands expert knowledge. A software-based expert system, the therapy advisor (TA), was developed, which analyzes stored data and provides reprogramming recommendations. This study addresses whether pacemaker experts consider the messages that are automatically generated appropriate in the management of atrial tachyarrhythmias/atrial fibrillation (AT/AF). This observational, international, multicenter study follows 150 patients with suspected or documented atrial arrhythmias who received a dual-chamber pacemaker (model Vitatron T-70, Medtronic Inc., Minneapolis, MN, USA) incorporating the TA. The TA summarizes technical and clinical data stored in the pacemaker into key messages and may suggest programming changes. Twenty-five cardiologists examined their patients per normal practice during two follow-up visits. They reported the therapy changes they deemed necessary without initially reviewing the TA messages. Next, they rated their satisfaction with and the clinical relevance of the TA messages and recorded the final therapy changes. The TA generated (mostly AT/AF-related) main observations in 49% and programming advice in 33% of the patients. The experts rated 95% of the TA messages as satisfactory and deemed therapy changes necessary in roughly half the patients. Pacemaker changes in AT/AF therapy or general settings were prompted primarily by the diagnostic information stored in the device. Medication changes were mostly led by the symptoms reported by the patient. This study demonstrates that experienced cardiologists agree with 95% of the observations and programming suggestions that the TA automatically generates.Pacing and Clinical Electrophysiology 05/2010; 33(5):605-14. · 1.35 Impact Factor
Article: [Alternative methods of microvolt T wave alternans measurements in patients with left ventricular cardiac dysfunction].Lubomír Krivan, Petr Lokaj, Milan Kozák, Milan Sepsi, Pavel Trcka, Jitka Vlasínová, Lucie Buresová, Jindrich Spinar[show abstract] [hide abstract]
ABSTRACT: The presence of a microvolt T wave alternans (MTWA) is linked with increased risk of malignant arrhythmias and overall mortality. The most common method used for MTWA detection is a bicycle exercise test (BET). Method has still several limitations. To confirm that comparable MTWA results may be obtained by atrial and ventricular pacing during electrophysiology. To identify an anticipated relation between MTWA and malignant arrhythmia occurrence, or a death. We obtained MTWA during BET and consequently during atrial and ventricular pacing. All patients underwent a routine electrophysiology testing prior to prophylactic ICD implantation. The results were compared. The occurrence of malignant arrhythmias and death were registered during follow-up. The group consisted of 39 patients. The results of MTWA obtained by BET, atrial and ventricular pacing did not show a significant difference. No difference was found among the three methods in the number of positive leads, and onset heart rate. Ventricular pacing increases the magnitude of MTWA comparing to the remaining two methods. No relation between MTWA results and occurrence of malignant arrhythmias or death was found. Atrial and ventricular pacing lead to comparable MTWA results as BET and may be used as alternative methods in patients where BET is not feasible.Casopís lékar̆ů c̆eských 01/2010; 149(9):423-8.
Article: [Analysis and comparison of cohorts of patients with implantable cardioverter-defibrillator in primary and secondary prevention].[show abstract] [hide abstract]
ABSTRACT: The aim of this study was an analysis of patients with ICD implanted in primary prevention (PP) in long-term follow-up and comparison with data obtained in secondary prevention patients (SP). We assessed 73 patients with PP ICD and 138 patients with SP ICD. Males were in majority with 88% in PP group and 78% in SP group. The average age was 63 years. Majority of patients suffered from coronary artery disease. The mean ejection fraction (LV EF) was 28% in PP patients and 38% in SP patients. The number of affected coronary arteries and medication were similar in both groups. We compared the occurrence of intercurrent diseases, malignant arrhythmias, inappropriate therapies, hospital readmissions and patients' survival. PP patients had lower LV EF ejection fraction (p < 0.001), higher number of revascularized arteries (p < 0.001) and lower occurrence of inappropriate therapies and arrhythmic storms (p < 0.001). There was higher number of patients with diabetes (p = 0.009), dyslipidemia (p < 0.001) and cerebral artery disease (p = 0.017) among those in PP group. Renal insufficiency was related to a higher risk of death. Patients with PP ICD implantation have lower LVEF, and more intercurrent diseases then patients with ICD implanted form SP reasons. Their myocardium is more often revascularized and the occurrence of inappropriate therapy is low. Arrhythmic storm is a typical feature of patients with ICD implanted in secondary prevention.Vnitr̆ní lékar̆ství 02/2010; 56(2):99-105.
Article: [Influence of spontaneous ventricular premature beat coupling interval on the value of heart rate turbulence].[show abstract] [hide abstract]
ABSTRACT: The heart rate turbulence is promising marker of a sudden cardiac death. The aim of the study is to evaluate the influence of the ventricular premature beat (VPB) coupling interval on the values of turbulence onset (TO) and turbulence slope (TS) parameters in the three groups of patients--"healthy" with ventricular premature beats, pts post myocardial infarction (MI) and pts with chronic heart failure with the left ventricle ejection fraction (LVEF) < 0.35. 382 pts were examined: healthy--149, post MI--123 and LVEF < 0.35 - 110. The distribution ofVPB was analyzed and the values ofTO and TS were evaluated according to the coupling intervals of VPB--in the intervals 00-50, 51-100 (% of RR interval) and in the intervals 34-66 and 67-100 (% of RR interval). The coupling interval of spontaneous ventricular premature beats cause the statistically significant variability HRT values in all three groups of pts. The values of TO in the groups of post MI pts and pts with chronic heart failure are higher (risky for sudden cardiac death) after VPB with longer coupling intervals (50-100%, event. 67-100% of RR interval). The TS values are lower (risky for sudden cardiac death) after VPB with longer coupling interval, too. For evaluation of HRT we should use the VPBs with long coupling intervals.Vnitr̆ní lékar̆ství 09/2008; 54(9):803-9.
Article: The screening for X-linked Emery-Dreifuss muscular dystrophy amongst young patients with idiopathic heart conduction system disease treated by a pacemaker implant.[show abstract] [hide abstract]
ABSTRACT: The X-linked Emery-Dreifuss muscular dystrophy (X-EDMD) is a hereditary muscle disorder associated with cardiac involvement. Sinus node dysfunction and atrioventricular conduction defects, typical of X-EDMD, occur in both males and females and may result in sudden cardiac death unless treated by permanent pacing. The objective of the study was to determine the frequency and relevance of X-EDMD in heart conduction system disease in young individuals treated with a pacemaker implant. The medical history of 3450 paced individuals in the region of South Moravia, Czech republic, was reviewed. Thirty-five patients, 20 males and 15 females, with idiopathic heart conduction disease of onset before age 40 were identified and screened for X-EDMD. Within these 35 individuals, only one male was found to carry a mutation in X-EDMD gene. We conclude that the clinical relevance of X-EDMD in heart conduction system disease is very low. It should, however, be included into the diagnostic work-up of young male individuals with idiopathic cardiac conduction disturbances.European Journal of Neurology 09/2004; 11(8):531-4. · 3.69 Impact Factor