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Capucci A, Luzi M, Cipolletta L, Molini S. Health economic concerns on cardiac rhythm management devices longevity and how to overcome them. Expert Rev Med Devices 2016; 13:297-303. [PMID: 26778415 DOI: 10.1586/17434440.2016.1142871] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The number of device implantations is in constant increase due to the ageing population, extended indications to implant for preventing sudden cardiac death and treating heart failure. An increase in the number of implants is directly related to a higher number of device replacements and that is one of the most important risk factors for device infection. Therefore, all the above mentioned factors contribute to an increase in the cost for health care system. Currently, several methods help to prolong device battery longevity and consequently reduce the costs, such as: a new battery, drug eluting leads, high impedance leads, algorithm to minimize unnecessary pacing, capture management and correct programming to avoid inappropriate and unnecessary shock in Implantable Cardioverter Defibrillators and Cardiac Resynchronization Therapy devices. Furthermore remote monitoring is very promising to reduce health system costs related to devices.
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Affiliation(s)
| | - Mario Luzi
- a Cardiology Clinic , Marche Polytechnic University , Ancona , Italy
| | - Laura Cipolletta
- a Cardiology Clinic , Marche Polytechnic University , Ancona , Italy
| | - Silvano Molini
- a Cardiology Clinic , Marche Polytechnic University , Ancona , Italy
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Bauer A, Vermeulen J, Toivonen L, Voitk J, Barr C, Peytchev P. Minimizing right ventricular pacing in pacemaker patients with intact and compromised atrioventricular conduction : Results from the EVITA Trial. Herzschrittmacherther Elektrophysiol 2015; 26:359-366. [PMID: 26315154 DOI: 10.1007/s00399-015-0394-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Accepted: 06/01/2015] [Indexed: 06/04/2023]
Abstract
INTRODUCTION Unnecessary ventricular pacing is associated with increased morbidity and mortality. Over the years different algorithms have been developed to reduce right ventricular pacing. OBJECTIVES Goal of the present study was to test the efficacy of the ventricular intrinsic preference (VIP) algorithm in patients with atrioventricular intact (AVi) and atrioventricular compromised (AVc) AV-conduction. METHODS Evaluation of VIP feature in pacemaker patients (EVITA) was a multicenter, prospective, randomized trial (Trials.gov Identifier: NCT00366158). In total, 389 patients were randomized to AVc group: n = 140/132 VIP OFF/VIP On, AVi group: n = 54/63 VIP OFF/VIP ON). One-month post-implantation AV conduction testing (AVc: PR/AR interval > 210 ms) was performed. Follow-up visits occurred 6 and 12 months after DDD-pacemaker implantation. RESULTS In AVi and AVc-patients initiation of the VIP feature significantly reduced incidence of ventricular pacing (AVi: 53 ± 38 vs. 9 ± 21%, p = 0.0001; AVc: 79 ± 31 vs. 28 ± 35%, p = 0.0001). DDD-pacemaker implantation per se significantly reduced incidence of AF in VIP ON (AVi 27 vs. 0%, p < 0.0001; AVc 29 vs. 3%, p < 0.0001) and VIP OFF patients (AVi 43 vs. 4%, p < 0.0001; AVc 33 vs. 3, p < 0.0001), without significant differences between VIP ON and OFF groups (p > 0.05). In the AVc group activation of VIP significantly reduced incidence of adverse events (AE). All-cause mortality was not significantly different in VIP ON (n = 5) and VIP OFF (n = 4, p > 0.05) patients. CONCLUSION AV search hysteresis (VIP) markedly reduces ventricular pacing both in patients with normal AV conduction and in patients with prolonged PR interval or intermittent AV block.
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Affiliation(s)
- A Bauer
- Department of Cardiology, Diakonieklinikum Schwäbisch Hall/Klinikum Crailsheim, Diakoniestrasse 12, 74523, Schwäbisch Hall, Germany.
| | | | - L Toivonen
- Helsinki University Central Hospital, Helsinki, Finland
| | - J Voitk
- Mustamae Hospital, Tallin, Estonia
| | - C Barr
- Russels-Hall Hospital, Dudley, United Kingdom
| | - P Peytchev
- O.L. Vrouwziekenhuis Campus, Asse, Belgium
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Yadav R, Jaswal A, Chennapragada S, Kamath P, Hiremath SMS, Kahali D, Anand S, Sood NK, Mishra A, Makkar JS, Kaul U. Effectiveness of Ventricular Intrinsic Preference (VIP™) and Ventricular AutoCapture (VAC) algorithms in pacemaker patients: Results of the validate study. J Arrhythm 2015; 32:29-35. [PMID: 26949428 PMCID: PMC4759122 DOI: 10.1016/j.joa.2015.07.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Revised: 07/08/2015] [Accepted: 07/14/2015] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Several past clinical studies have demonstrated that frequent and unnecessary right ventricular pacing in patients with sick sinus syndrome and compromised atrio-ventricular conduction (AVC) produces long-term adverse effects. The safety and efficacy of two pacemaker algorithms, Ventricular Intrinsic Preference™ (VIP) and Ventricular AutoCapture (VAC), were evaluated in a multi-center study in pacemaker patients. METHODS We evaluated 80 patients across 10 centers in India. Patients were enrolled within 15 days of dual chamber pacemaker (DDDR) implantation, and within 45 days thereafter were classified to either a compromised AVC (cAVC) arm or an intact AVC (iAVC) arm based on intrinsic paced/sensed (AV/PV) delays. In each arm, patients were then randomized (1:1) into the following groups: VIP OFF and VAC OFF (Control group; CG), or VIP ON and VAC ON (Treatment Group; TG). Subsequently, the AV/PV delays in the CG groups were mandatorily programmed at 180/150 ms, and to up to 350 ms in the TG groups. The percentage of right ventricular pacing (%RVp) evaluated at 12-month post-implantation follow-ups were compared between the two groups in each arm. Additionally, in-clinic time required for collecting device data was compared between patients programmed with the automated AutoCapture algorithm activated (VAC ON) vs. the manually programmed method (VAC OFF). RESULTS Patients randomized to the TG with the VIP algorithm activated exhibited a significantly lower %RVp at 12 months than those in the CG in both the cAVC arm (39±41% vs. 97±3%; p=0.0004) and the iAVC arm (15±25% vs. 68±39%; p=0.0067). In-clinic time required to collect device data was less in patients with the VAC algorithm activated. No device-related adverse events were reported during the year-long study period. CONCLUSIONS In our study cohort, the use of the VIP algorithm significantly reduced the %RVp, while the VAC algorithm reduced in-clinic time needed to collect device data.
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Affiliation(s)
- Rakesh Yadav
- Department of Cardiology, All India Institute of Medical Science, New Delhi, India
| | - Aparna Jaswal
- Department of Cardiac Pacing & Electrophysiology, Fortis Escorts Heart Institute, New Delhi, India
| | | | - Prakash Kamath
- Department of Cardiology, Amrita Institute of Medical Science and Research Centre, Kochi, Kerala, India
| | | | - Dhiman Kahali
- Department of Cardiology, BM Birla Hospital, Kolkata, West Bengal, India
| | - Sumit Anand
- St. Jude Medical Pvt. Ltd., New Delhi, India
| | - Naresh K Sood
- Department of Cardiology, Hero DMC Hospital, Punjab, India
| | - Anil Mishra
- Department of Cardiology, BM Birla Hospital, Kolkata, West Bengal, India
| | | | - Upendra Kaul
- Department of Cardiology, Flt. Lt. Fortis Hospital, New Delhi, India
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Chen S, Chen K, Tao Q, Zheng L, Shen F, Wu S, Fan J, Xu G, Wang L, Zhou X, Zhang S. Reduction of unnecessary right ventricular pacing by managed ventricular pacing and search AV+ algorithms in pacemaker patients: 12-month follow-up results of a randomized study. ACTA ACUST UNITED AC 2014; 16:1595-602. [DOI: 10.1093/europace/euu055] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Pakarinen S, Toivonen L. Minimizing ventricular pacing by a novel atrioventricular (AV) delay hysteresis algorithm in patients with intact or compromised intrinsic AV conduction and different atrial and ventricular lead locations. Ann Med 2013; 45:438-45. [PMID: 23768003 DOI: 10.3109/07853890.2013.801710] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE To investigate if an advanced AV search hysteresis (AVSH) algorithm, Ventricular Intrinsic Preference (VIP(™)), reduces the incidence of ventricular pacing (VP) in sinus node dysfunction (SND) with both intact and compromised AV conduction and with intermittent AV block regardless of the lead positions in the right atria and the ventricle. METHODS Patients were classified as having intact AV (AVi) conduction if the PR interval was ≤ 210 ms on ECG and 1:1 AV conduction during atrial pacing up to 120 bpm with PR interval ≤ 350 ms. Otherwise the AV conduction was classified as compromised (AVc). Both AVi and AVc patients were randomized to VIP ON or OFF. VIP performed an intrinsic AV conduction search every 30 s for three consecutive atrial cycles with the extension of the sensed and paced AV (SAV/PAV) delays from basic values of 150/200 ms to 300/350 ms. Extended AV intervals were allowed for three cycles when VP occurred before returning to basic AV delays. The primary end-point was %VP at 12 months. RESULTS Among 389 patients, 30.1% had intact and 69.9% had compromised AV conduction. The mean %VP at 12 months was 9.6% by VIP compared to 51.8% with standard AV settings in patients with AVi (P < 0.0001) and 28.0% versus 78.9% (P < 0.0001) with AVc. With VIP, excessive %VP among most used lead positions was not seen. Conversely, when VIP was off %VP was low only in patients who had leads in the RA septal-RV septal position (23.0%). CONCLUSIONS VIP feature reduces VP both in patients with SND and with intermittent heart block regardless of the lead positions in the right atria and the ventricle.
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Affiliation(s)
- Sami Pakarinen
- Department of Cardiology, Helsinki University Central Hospital, Meilahti Hospital, Helsinki, Finland.
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Exner DV, Birnie DH, Moe G, Thibault B, Philippon F, Healey JS, Tang ASL, Larose É, Parkash R. Canadian Cardiovascular Society guidelines on the use of cardiac resynchronization therapy: evidence and patient selection. Can J Cardiol 2013; 29:182-95. [PMID: 23351926 DOI: 10.1016/j.cjca.2012.10.006] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2012] [Revised: 10/07/2012] [Accepted: 10/07/2012] [Indexed: 11/25/2022] Open
Abstract
Recent landmark trials provided the impetus to update the recommendations for cardiac resynchronization therapy (CRT). This article provides guidance on the prescription of CRT within the confines of published data. A future article will explore the implementation of these guidelines. These guidelines are intended to serve as a framework for the prescription of CRT within the Canadian health care system and beyond. They were developed through a critical evaluation of the existing literature, and expert consensus. The panel unanimously adopted each recommendation. The 8 recommendations relate to ensuring the adequacy of medical therapy before the initiation of CRT, the use of symptom severity to select candidates for CRT, differing recommendations based on the presence or absence of sinus rhythm, the presence of left bundle branch block vs other conduction patterns, and QRS duration. The use of CRT in the setting of chronic right ventricular pacing, left ventricular lead placement, and the routine assessment of dyssynchrony to guide the prescription of CRT are also included. The strength of evidence was weighed, taking full consideration of any risks of bias, as well as any imprecision, inconsistency, and indirectness of the available data. The strength of each recommendation and the quality of evidence were adjudicated. Trade-offs between desirable and undesirable consequences of alternative management strategies were considered, as were values, preferences, and resource availability. These guidelines were externally reviewed by experts, modified based on those reviews, and will be updated as new knowledge is acquired.
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Affiliation(s)
- Derek V Exner
- Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada.
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Chen KP, Xu G, Wu S, Tang B, Wang L, Zhang S. Clinical evaluation of pacemaker automatic capture management and atrioventricular interval extension algorithm. Europace 2012; 15:395-401. [PMID: 23243132 DOI: 10.1093/europace/eus309] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
AIMS The present study was to assess the accuracy of automatic atrial and ventricular capture management (ACM and VCM) in determining pacing threshold and the performance of a second-generation automatic atrioventricular (AV) interval extension algorithm for reducing unnecessary ventricular pacing. METHODS AND RESULTS A total of 398 patients at 32 centres who received an EnPulse dual-chamber pacing/dual-chamber adaptive rate pacing pacemaker (Medtronic, Minneapolis, MN, USA) were enrolled. The last amplitude thresholds as measured by ACM and VCM prior to the 6-month follow-up were compared with manually measured thresholds. Device diagnostics were used to evaluate ACM and VCM and the percentage of ventricular pacing with and without the AV extension algorithm. Modelling was performed to assess longevity gains relating to the use of automaticity features. Atrial and ventricular capture management performed accurately and reliably provided complete capture management in 97% of studied patients. The AV interval extension algorithm reduced the median per cent of right ventricular pacing in patients with sinus node dysfunction from 99.7 to 1.5% at 6-month follow-up and in patients with intermittent AV block (excluding persistent 3° AV block) from 99.9 to 50.2%. On the basis of validated modelling, estimated device longevity could potentially be extended by 1.9 years through the use of the capture management and AV interval extension features. CONCLUSION Both ACM and VCM features reliably measured thresholds in nearly all patients; the AV extension algorithm significantly reduced ventricular pacing; and the use of pacemaker automaticity features potentially extends device longevity.
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Affiliation(s)
- Ke-ping Chen
- Clinical EP Lab and Arrhythmic Center, Fuwai Hospital, Beijing, China
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Poghosyan HR, Jamalyan SV. Comparison of pacing algorithms to avoid unnecessary ventricular pacing in patients with sick sinus node syndrome: a single-centre, observational, parallel study. Europace 2012; 14:1483-9. [PMID: 22628453 DOI: 10.1093/europace/eur415] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
AIMS Reduction of unnecessary ventricular pacing (uVP) is an essential component in the treatment strategy in any pacing population in general. The aim of this study was to evaluate the efficacy of different algorithms to reduce uVP in an adult population with sick sinus syndrome (SSS) treated outside of clinical trials. Evaluation of the relationship between different types of pacing algorithms and clinical outcomes is also provided. METHODS AND RESULTS This was a single-centre, observational, parallel study, based on retrospective analysis of the Arrhythmology Cardiology Center of Armenia electronic clinical database. This study evaluated atrial pacing percentage (AP%), ventricular pacing percentage (VP%), and the incidence of atrial high rate episodes in 56 patients with SSS using three different pacing strategies: managed VP, search atrioventricular (AV), and fixed long AV. We did not find statistically significant differences in the amount of VP between the groups. Although the atrial high rate percentage (AHR%) tended to be higher in the fixed long AV group, this difference was not statistically significant. Mean VP% and AP% were similar in all three groups. CONCLUSIONS In our study, all three programmed strategies produced the same mean AP% and VP%, and were equally efficient in uVP reduction. There was no relationship between chosen algorithms and the incidence of pacemaker syndrome, hospitalizations, or change in New York Heart Association class. The percentage of AHR was not associated with pacing strategy or co-morbidities but showed borderline correlation with left atrial size.
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KOLB CHRISTOF, SCHMIDT ROLAND, DIETL JOSEFU, WEYERBROCK SONJA, MORGENSTERN MARTIN, FLECKENSTEIN MARTIN, BEIER THOMAS, VON BARY CHRISTIAN, MACKES KARLG, WIDMAIER JOCHEN, KREUZER JÖRG, SEMMLER VERENA, ZRENNER BERNHARD. Reduction of Right Ventricular Pacing with Advanced Atrioventricular Search Hysteresis: Results of the PREVENT Study. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2011; 34:975-83. [DOI: 10.1111/j.1540-8159.2011.03075.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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ROSENTHAL LAWRENCES, MESTER STEVEN, RAKOVEC PETER, PENARANDA JBENEZET, SHERMAN JONR, SHELDON TODDJ, ZENG CATHY, WANG PAUL. Factors Influencing Pacemaker Generator Longevity: Results from the Complete Automatic Pacing Threshold Utilization Recorded in the CAPTURE Trial. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2010; 33:1020-30. [DOI: 10.1111/j.1540-8159.2010.02809.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Murakami Y, Tsuboi N, Inden Y, Yoshida Y, Murohara T, Ihara Z, Takami M. Difference in percentage of ventricular pacing between two algorithms for minimizing ventricular pacing: results of the IDEAL RVP (Identify the Best Algorithm for Reducing Unnecessary Right Ventricular Pacing) study. Europace 2010; 12:96-102. [PMID: 19762332 PMCID: PMC2793021 DOI: 10.1093/europace/eup252] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
AIMS Managed ventricular pacing (MVP) and Search AV+ are representative dual-chamber pacing algorithms for minimizing ventricular pacing (VP). This randomized, crossover study aimed to examine the difference in ability to reduce percentage of VP (%VP) between these two algorithms. METHODS AND RESULTS Symptomatic bradyarrhythmia patients implanted with a pacemaker equipped with both algorithms (Adapta DR, Medtronic) were enrolled. The %VPs of the patients during two periods were compared: 1 month operation of either one of the two algorithms for each period. All patients were categorized into subgroups according to the atrioventricular block (AVB) status at baseline: no AVB (nAVB), first-degree AVB (1AVB), second-degree AVB (2AVB), episodic third-degree AVB (e3AVB), and persistent third-degree AVB (p3AVB). Data were available from 127 patients for the analysis. For all patient subgroups, except for p3AVB category, the median %VPs were lower during the MVP operation than those during the Search AV+ (nAVB: 0.2 vs. 0.8%, P < 0.0001; 1AVB: 2.3 vs. 27.4%, P = 0.001; 2AVB: 16.4% vs. 91.9%, P = 0.0052; e3AVB: 37.7% vs. 92.7%, P = 0.0003). CONCLUSION Managed ventricular pacing algorithm, when compared with Search AV+, offers further %VP reduction in patients implanted with a dual-chamber pacemaker, except for patients diagnosed with persistent loss of atrioventricular conduction.
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Affiliation(s)
- Yoshimasa Murakami
- Cardiovascular Center, Higashi Municipal Hospital, City of Nagoya, 1-2-23 Wakamizu, Chikusa-ku, Nagoya 464-8547, Japan.
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Lian J, Garner G, Kratschmer H, Mussig D. Simulation of AV hysteresis pacing using an integrated dual chamber heart and pacer model. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2009; 2009:3932-5. [PMID: 19963804 DOI: 10.1109/iembs.2009.5333095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Long term right ventricular apical pacing has been known to have adverse effects in cardiac function. The AV hysteresis (AVH) is a feature existing in many dual-chamber cardiac pacemakers that aims to minimize the right ventricular pacing, but its clinical efficacy remains inconclusive due to conflicting evidence from different studies. We have recently developed a novel integrated dual-chamber heart and pacer (IDHP) model, which can simulate various interactions between intrinsic heart activity and extrinsic cardiac pacing. In this study, we use the IDHP model to simulate various atrio-ventricular (AV) conduction pathologies, and to investigate the effects of an AVH algorithm on reducing right ventricular pacing. Our results show that the efficacy of AVH is dependent on the underlying cardiac conditions. While it can preserve intrinsic conduction during minor or moderate first degree AV block, its efficacy is reduced at higher degree AV block conditions. This pilot study further supports using the IDHP model to design and evaluate more advanced pacemaker algorithms for therapeutic interventions.
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Affiliation(s)
- Jie Lian
- Micro Systems Engineering, Inc., Lake Oswego, OR 97035, USA.
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DAS MITHILESHK, DANDAMUDI GOPI, STEINER HILLELA. Modern Pacemakers: Hope or Hype? PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2009; 32:1207-21. [DOI: 10.1111/j.1540-8159.2009.02467.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Das M. Indications for ICD and cardiac resynchronization therapy for prevention of sudden cardiac death. Expert Rev Cardiovasc Ther 2009; 7:181-95. [PMID: 19210214 DOI: 10.1586/14779072.7.2.181] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
The implantable cardioverter-defibrillator (ICD) is used for primary and secondary prophylaxis of sudden cardiac death in high-risk patients. While several trials have demonstrated the superiority of ICD over standard medical therapy or antiarrhythmic medication in this population, a few trials have not shown survival benefit. The Multicenter Automatic Defibrillator Implant Trial II study revealed that ICD reduces mortality in patients with ischemic cardiomyopathy. The Sudden Cardiac Death-Heart Failure Trial demonstrated that the ICD prevents sudden cardiac death and all-cause mortality in high-risk patients with moderate ischemic and nonischemic cardiomyopathy and heart failure. The ICD is also recommended for high-risk patients with inherited arrhythmia or cardiomyopathy. Cardiac resynchronization therapy reduces mortality and heart failure class as compared with optimal medical therapy in advanced heart failure. The high economic cost of widespread ICD use must also be considered. Therefore, it is prudent to identify a high-risk population who will benefit most from these devices.
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Affiliation(s)
- Mithilesh Das
- Krannert Institute of Cardiology, Roudebush VA Medical Center, Indiana University School of Medicine, IN, USA.
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Wiegand UKH. [Avoidance of ventricular pacing in patients with sinus node disease or intermittent AV block]. Herzschrittmacherther Elektrophysiol 2008; 19:3-10. [PMID: 18330670 DOI: 10.1007/s00399-008-0595-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2008] [Accepted: 02/15/2008] [Indexed: 05/26/2023]
Abstract
In patients with frequent right ventricular stimulation, worsening of heart failure and atrial fibrillation may occur. Avoidance of unnecessary right ventricular pacing is a major requirement for pacemaker selection and programming in patients with sinus node disease or intermittent AV block. In dual chamber pacemakers this goal can be achieved by programming a long AV delay or an AV delay hysteresis. Algorithms that allow AAI pacing in a dual chamber pacing mode and change to DDD mode in case of high degree AV block are a new attempt to avoid unnecessary right ventricular pacing. The article describes various strategies to avoid unnecessary ventricular pacing and discusses their advantages and disadvantages.
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Affiliation(s)
- U K H Wiegand
- Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Medizinische Klinik II, Ratzeburger Allee 160, 23538 Lübeck, Germany.
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PÜRERFELLNER HELMUT, BRANDT JOHAN, ISRAEL CARSTEN, SHELDON TODD, JOHNSON JAMES, TSCHELIESSNIGG KARLHEINZ, SPERZEL JOHANNES, BORIANI GIUSEPPE, PUGLISI ANDREA, MILASINOVIC GORAN. Comparison of Two Strategies to Reduce Ventricular Pacing in Pacemaker Patients. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2008; 31:167-76. [DOI: 10.1111/j.1540-8159.2007.00965.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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BERTINI MATTEO, BIFFI MAURO, ZIACCHI MATTEO, VALZANIA CINZIA, SAPORITO DAVIDE, BORIANI GIUSEPPE. Automatic Verification of Ventricular Stimulation: Fusion Management Algorithm. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2007; 31:64-9. [DOI: 10.1111/j.1540-8159.2007.00926.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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BIFFI MAURO, SPITALI GIROLAMO, SILVETTI MASSIMOSTEFANO, ARGNANI SELINA, RUBINO IDA, FONTANA PIERLUIGI, BARBATO GAETANO, MAZZINI ELENA, DE SANTO TIZIANA, DRAGO FABRIZIO, BORIANI GIUSEPPE. Atrial Threshold Variability: Implications for Automatic Atrial Stimulation Algorithms. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2007; 30:1445-54. [DOI: 10.1111/j.1540-8159.2007.00890.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Abstract
Physiologic pacing is an evolving term used to describe different concepts and technologic developments in implantable devices (including pacemakers and defibrillators) over the past several decades. Currently much of the discussion about optimal physiologic pacing involves fairly recently appreciated deleterious effects of traditional right ventricular pacing. Technologic solutions to the goal of avoiding unnecessary ventricular pacing appear to be available and successful. Although much work is being done to find more physiologic ways to pace the ventricles when necessary, the solutions for this goal are less clear.
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Affiliation(s)
- Dwight W Reynolds
- Cardiovascular Section, The University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA.
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Ruiz-Mateas F, Sancho-Tello MJ, Coma-Sanmartín R, Fidalgo-Andrés M, Martínez-Ferrere J, García-Calabozo R. Novedades en estimulación cardiaca 2006. Rev Esp Cardiol (Engl Ed) 2007; 60 Suppl 1:92-100. [PMID: 17352859 DOI: 10.1157/13099716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
This article summarizes progress in cardiac pacing that has taken place in the last year, such as the incorporation of navigation technology into programmers, systems for monitoring hemodynamic parameters, and new developments in patient follow-up, principally home monitoring and the use of treatment guidelines. In addition, the article covers recent findings in resynchronization therapy, paroxysmal atrial fibrillation, and the management of patients with pacemakers who need to undergo magnetic resonance imaging.
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Affiliation(s)
- Francisco Ruiz-Mateas
- Unidad de Estimulación Cardiaca, Unidad de Cardiología, Hospital Costa del Sol, Marbella, España
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