Background & objectives: The clinical benefit of optimization (OPT) of atrioventricular delay (AV... more Background & objectives: The clinical benefit of optimization (OPT) of atrioventricular delay (AVD) and interventricular delay (VVD) in cardiac resynchronization therapy (CRT) remains debatable. This study was aimed to determine the influence of AVD and VVD OPT on selected parameters in patients early after CRT implantation and at mid-term follow up (FU). Methods: Fifty two patients (61±10 yr, 23 males) with left bundle branch block, left ventricular ejection fraction (LVEF) ≤35 per cent and heart failure were selected for CRT implantation. Early on the second day (2DFU) after CRT implantation, the patients were assigned to the OPT or the factory setting (FS) group. Haemodynamic and electrical parameters were evaluated at baseline, on 2DFU after CRT and mid-term FU [three-month FU (3MFU)]. Echocardiographic measures were assessed before implantation and at 3MFU. The AVD/VVD was deemed optimal for the highest cardiac output (CO) with impedance cardiography (ICG) monitoring. Results: On 2DFU, the AVD was shorter in the OPT group, LV was paced earlier than in FS group and CO was insignificantly higher in OPT group. At 3MFU, improvement of CO was observed only in OPT patients, but the intergroup difference was not significant. At 3MFU in OPT group, reduction of LV in terms of LV end-diastolic diameter (LVeDD), LV end-systolic diameter, LV end-diastolic and systolic volume with the improvement in LVEF was observed. In FS group, only a reduction in LVeDD was present. In OPT group, the paced QRS duration was shorter than in FS group patients. Interpretation & conclusions: CRT OPT of AVD and VVD with ICG was associated with a higher CO and better reverse LV remodelling. CO monitoring with ICG is a simple, non-invasive tool to optimize CRT devices.
Background: Twenty four hour Holter monitoring (HM) in an early post-implantation period in asymp... more Background: Twenty four hour Holter monitoring (HM) in an early post-implantation period in asymptomatic patients is considered as class IIb according to the ACC/AHA guidelines. It seems that post-implantation assessment extended by 24 hour HM in these patients might shorten hospitalization and increase safety of these patients. This aspect has not been widely discussed so far. The aim of our study was to evaluate pacing and sensing disturbances in asymptomatic patients with proper parameters of single and double chamber pacemakers. Methods: Studied group included 236 patients implanted with Biotronik Actros S (single chamber) (group I-130 patients) and Biotronik Actros D or Axios D (group II-106 patients) pacemakers. In all the patients 24 hour HM was performed 1-6 days after implantation (mean 3.4) in order to assess all pacing and sensing disturbances. Results: Sensing disturbances were found in 2 patients from group I and 22 patients from group II (the most frequent pacemaker failure was atrial undersensing followed by ventricular oversensing-T wave stering). In 1 patient from group I atrial failure to pace was observed. In whole group pacing/sensing disturbances were found in 23% of patients, nevertheless they did not provoke any hemodynamic consequences. Conclusions: In an early post-implantation period pacemaker disturbances occur in 23% of asymptomatic patients being more frequent in patients with dual chamber pacemaker. Atrial undersensing and ventricular oversensing are the most common disturbances, nevertheless having no hemodynamic consequences they are not life-threatening. Detection of these episodes in an early post-implantation period allows for early change in pacemakers' parameters and thus decreasing risk of rehospitalization. We confirmed the low usefulness of HM in patients with single chamber pacemaker early after implantation.
Background: It has been reported that bifocal pacing (BiF) in the right ventricle might be an alt... more Background: It has been reported that bifocal pacing (BiF) in the right ventricle might be an alternative to unsuccessful left ventricular lead implantation. This case report presents an assessment of the clinical and hemodynamic parameters during a three month follow-up in patients implanted with right ventricular BiF. Methods: Eight patients who underwent unsuccessful left ventricular lead implantation were implanted with a bifocal system in the right ventricular. Leads were implanted in the right atrium appendage, the apex and the right ventricular outflow tract and connected to the cardiac resynchronization therapy pacemaker. All patients performed a sixminute walking test and underwent echocardiography after the implantation and after the three month follow-up. Results: We found a significant performance increase in the six minute walking test and reduction in New York Heart Association class and mitral regurgitation in echocardiography study, as well as a significant increase in left ventricular ejection fraction, and cardiac output directly after the implantation, as well as at threemonth follow-up in patients after BiF implantation. Conclusions: Right ventricular bifocal pacing in patients with cardiac resynchronization therapy indication and unsuccessful left ventricular lead placement seems to be a beneficial treatment for heart failure. Satisfactory hemodynamic and clinical results were observed directly after BiF implantation and during the three month follow-up.
The population of patients with a pacemaker is constantly growing in number. Myocardial infarctio... more The population of patients with a pacemaker is constantly growing in number. Myocardial infarction in these patients, like in patients with left bundle branch block (LBBB), is called the undetermined type and characterizes the highest risk of death. Therefore the early and correct diagnosis of AMI is very important. The electrocardiographic criteria of the recognition of acute myocardial infarction (AMI) in patients with a ventricular pacing are similar to the electrocardiographic criteria of the recognition of AMI in patients with LBBB. They are applicable in the first phase of AMI's diagnostic process and they are known as Sgarbossa's criteria. However, one should remember about differences between these two groups of patients and therefore particular criteria have got different significance in patients from each group. There are three Sgarbossa's criteria: ST-segment elevation of >/= 5 mm in the presence of a negative QRS complex, ST-segment elevation of >/= 1 mm in the presence of a positive QRS complex and ST-segment depression of >/= 1 mm in lead V1, V2 or V3. In spite of all limitations of use ECG records in the recognition of AMI in patients with a ventricular pacing it should be remembered, that this method (together with a typical medical history) is still the simplest, the cheapest and the most available means of an early diagnosis of AMI. In patients with chest pain, the presence of a pacemaker should not defer the execution of ECG recording because ECG may be very helpful in establishing of the diagnosis. (Cardiol J 2007; 14: 207-213).
Introduction: There is no consensus on the length of ECG tracing that should be recorded to repre... more Introduction: There is no consensus on the length of ECG tracing that should be recorded to represent adequate rate control in patients with atrial fibrillation (AFib). The purpose of the study was to examine whether heart rate measurements based on short-term ECGs recorded at different periods of the day may correspond to the mean heart rate and rate irregularity analyzed from standard 24-hour Holter monitoring. Material and methods: The study enrolled 50 consecutive patients with chronic AFib who underwent 24-hour Holter monitoring. Mean heart rate (mHR) and the coefficient of irregularity (CI) were assessed from 5-and 60-minute intervals of Holter recordings in different periods of the day. Results: The highest correlation in mean heart rate interval within 24 h was found during a 6-hour sample and in the periods 11.00 AM-12.00 PM, 12 PM-1.00 PM, and 1.00 PM-2.00 PM. With respect to irregularity, only the CI measurements based on a 6-hour interval (7.00 AM-1.00 AM) show a correlation > 0.08 compared to data from the 24-hour recording. Conclusions: Only long-term (6-hour) recordings provide a high correlation within 24 h in mean heart rate interval and coefficient of irregularity. It seems that the mean heart rate interval in 1-hour periods between 11 AM and 2 PM might be predictive for 24-hour data. Short time recordings of the coefficient of irregularity of heart rate in AFib patients at this moment are not useful in clinical practice for long-term prognosis of ventricular irregularity.
Background: Atrial fibrillation (AF) is the most common form of cardiac arrhythmia. A number of s... more Background: Atrial fibrillation (AF) is the most common form of cardiac arrhythmia. A number of studies have demonstrated that heart rate control is the first line therapy for patients with AF. However, the correct ventricular rate and the parameters to be assessed are still open to question. The aim of the study was to evaluate whether mean heart rate (mHR) in 24-hour ECG Holter monitoring (HM) is useful parameter for the assessment of ventricular rhythm control in patients with AF. Additionally, we investigated whether other parameters such as episodes of tachy AF, irregularity of rhythm and the patient's awareness of "palpitations" play an important role in controlling ventricular rate in AF. Methods: Patients with chronic brady-tachy AF who had undergone VVI pacemaker implantation between 2 and 9 days earlier (a mean of 5.6 days previously) with optimal pharmacotherapy and mHR below 90 bpm were enrolled in this study. The studied parameters included mHR and the coefficient of irregularity (CI), based on HM and the percentage of fast ventricular rates (tachy AF episodes defined as a heart rate of > 120 bpm) derived from the pacemaker memory data. Symptoms such as "palpitations" were marked with a "+" over a period of 24 hours. Results: Forty two patients (18 male, 24 female) with a mean age of 70.2 ± 8 years were included in the study. Their mHR in HM ranged from 48 bpm to 79 bpm, with a mean of 64.8 ± ± 7.5 bpm. Despite of a correct mHR, in 21 patients (50%) tachy AF episodes were observed. accounting for 1% to 8% beats, with a mean of 2.7 ± 2.02%. CI in HM varied from 0.9 to 0.33 with a mean of 0.23 ± 0.06. Significant irregularity, a CI above 0.2, together with a correct mHR was found in 73% patients. In the majority of patients with a low CI of < 0.2 (10 out of 11) there were no tachy AF episodes. A significant CI (> 0.2) was found in 10 out of 18 patients (56%) with a correct mHR and without tachy AF episodes. Palpitations were noted in 16 out of 21 patients with the correct mHR who had tachy AF episodes and 9 out of 10, also with the correct mHR, in whom no such episodes were recorded. All these patients had a significant ventricular rate irregularity with a CI of > 0.2. Conclusions: The parameter of mHR derived from HM is not sufficient for controlling ventricular rate in the majority of patients with brady-tachy AF. It seems that evaluating tachy Editorial p. 443 474
Background: Biventricular pacing has demonstrated benefit for patients with congestive heart fail... more Background: Biventricular pacing has demonstrated benefit for patients with congestive heart failure although in 5-15% unsuccessful left ventricular lead implantation is reported. Alternative for failed transvenous left ventricular implantation is epicardiac approach with thoracotomy. Unfortunately this method is associated with very serious complications. Additionally this method increases the costs of the procedures and is available in cardiosurgery units only. It is reported that bifocal pacing in right ventricle might be alternative for unsuccessful left ventricular lead (LVlead) implantation. The aim of the study was clinical and hemodynamic assessment, during 3 month follow up (3mFU) of patients in which bifocal pacing (BiF) in right ventricle was used, for a standard transvenous BiV procedures proved to be ineffective or unsatisfactory. Material and methods: The eight patients with mean age 65 ± 9, in NYHA IV, with LVEF = = 22%, mean QRS duration = 180 ms with failed LVlead implantation were included to the study. In all patients leads in right atrium appendage and to the apex and outflow tract of the right ventricle were implanted and connected to the Stratos LV pacemaker (PM) Results: In patients after BiF implantation significant increase in 6 minute walking test was reported. There was no significant difference in QRS duration after procedure. Significant reduction in intraventricular mechanical delay, left ventricular systolic diameter and increase in EF, cardiac output and cardiac index in patients with BiF in ECHO study was assessed.
The aim of the study was to explore the relationship between changes in pulse pressure (PP) and f... more The aim of the study was to explore the relationship between changes in pulse pressure (PP) and frequency domain heart rate variability (HRV) components caused by left ventricular pacing in patients with implanted cardiac resynchronization therapy (CRT). Material/Methods: Forty patients (mean age 63±8.5 years) with chronic heart failure (CHF) and implanted CRT were enrolled in the study. The simultaneous 5-minute recording of beat-to-beat arterial systolic and diastolic blood pressure (SBP and DBP) by Finometer and standard electrocardiogram with CRT switched off (CRT/0) and left ventricular pacing (CRT/LV) was performed. PP (PP=SBP-DBP) and low-and high-frequency (LF and HF) HRV components were calculated, and the relationship between these parameters was analyzed. Results: Short-term CRT/LV in comparison to CRT/0 caused a statistically significant increase in the values of PP (P<0.05), LF (P<0.05), and HF (P<0.05). A statistically significant correlation between DPP and DHF (R=0.7384, P<0.05) was observed. The DHF of 6 ms 2 during short-term CRT/LV predicted a PP increase of ³10% with 84.21% sensitivity and 85.71% specificity. Conclusions: During short-term left ventricular pacing in patients with CRT, a significant correlation between DPP and DHF was observed. DHF ³6 ms 2 may serve as a tool in the selection of a suitable site for placement of a left ventricular lead.
I In nt tr ro od du uc ct ti io on n: : We sought to determine the usefulness of ambulatory 24-ho... more I In nt tr ro od du uc ct ti io on n: : We sought to determine the usefulness of ambulatory 24-hour Holter monitoring in detecting asymptomatic pacemaker (PM) malfunction episodes in patients with dual-chamber pacemakers whose pacing and sensing parameters were proper, as seen in routine post-implantation follow-ups. M Ma at te er ri ia al l a an nd d m me et th ho od ds s: : Ambulatory 24-hour Holter recordings (HM) were performed in 100 patients with DDD pacemakers 1 day after the implantation. Only asymptomatic patients with proper pacing and sensing parameters (assessed on PM telemetry on the first day post-implantation) were enrolled in the study. The following parameters were assessed: failure to pace, failure to sense (both oversensing and undersensing episodes) as well as the percentage of all PM disturbances. R Re es su ul lt ts s: : Despite proper sensing and pacing parameters, HM revealed PM disturbances in 23 patients out of 100 (23%). Atrial undersensing episodes were found in 12 patients (p < 0.005) with totally 963 episodes and failure to capture in 1 patient (1%). T wave oversensing was the most common ventricular channel disorder (1316 episodes in 9 patients, p < 0.0005). Malfunction episodes occurred sporadically, leading to pauses of up to 1.6 s or temporary bradycardia, which were, nevertheless, not accompanied by clinical symptoms. No ventricular pacing disturbances were found. C Co on nc cl lu us si io on ns s: : Asymptomatic pacemaker dysfunction may be observed in nearly 25% of patients with proper DDD parameters after implantation. Thus, ambulatory HM during the early post-implantation period may be a useful tool to detect the need to reprogram PM parameters. K Ke ey y w wo or rd ds s: : DDD pacemaker, ambulatory Holter monitoring, pacemaker dysfunction. C Co or rr re es sp po on nd di in ng g a au ut th ho or r: :
Background: Biventricular pacing has demonstrated benefit for patients with congestive heart fail... more Background: Biventricular pacing has demonstrated benefit for patients with congestive heart failure although in 5-15% unsuccessful left ventricular lead implantation is reported. Alternative for failed transvenous left ventricular implantation is epicardiac approach with thoracotomy. Unfortunately this method is associated with very serious complications. Additionally this method increases the costs of the procedures and is available in cardiosurgery units only. It is reported that bifocal pacing in right ventricle might be alternative for unsuccessful left ventricular lead (LVlead) implantation. The aim of the study was clinical and hemodynamic assessment, during 3 month follow up (3mFU) of patients in which bifocal pacing (BiF) in right ventricle was used, for a standard transvenous BiV procedures proved to be ineffective or unsatisfactory. Material and methods: The eight patients with mean age 65 ± 9, in NYHA IV, with LVEF = = 22%, mean QRS duration = 180 ms with failed LVlead implantation were included to the study. In all patients leads in right atrium appendage and to the apex and outflow tract of the right ventricle were implanted and connected to the Stratos LV pacemaker (PM) Results: In patients after BiF implantation significant increase in 6 minute walking test was reported. There was no significant difference in QRS duration after procedure. Significant reduction in intraventricular mechanical delay, left ventricular systolic diameter and increase in EF, cardiac output and cardiac index in patients with BiF in ECHO study was assessed.
Background: Device optimization is not routinely performed in patients who underwent cardiac resy... more Background: Device optimization is not routinely performed in patients who underwent cardiac resynchronization therapy (CRT) device implantation. Noninvasive optimization of CRT devices by measurement of cardiac output (CO) can be used as a simple method to assess ventricular systolic performance. The aim of this study was to assess whether optimization of atrioventricular (AV) and interventricular (VV) delay can improve hemodynamic response to CRT and whether this optimization should be performed for each patient individually. Methods: Twenty patients with advanced heart failure New York Heart Association (NYHA) class III/IV, left ventricular ejection fraction ≤ 35% and left bundle branch block (QRS ≥ 120 ms) in sinus rhythm were evaluated from 24 h to 48 h after implantation of a CRT device by means of impedance cardiography (ICG). CO was fi rst measured at each patient's intrinsic rhythm. Patients then underwent adjustments of AV and VV delay from 80 ms to 140 ms and from-60 ms to +60 ms, respectively in 20 ms increment steps and CO at each setting was measured by ICG. Both AV and VV delays were programmed according to the greatest improvement in CO compared to intrinsic rhythm. Results: There was a statistically signifi cant increase in CO measured at the intrinsic rhythm compared to different AV delay by mean of 21% (3.8 ± 1.0 vs. 4.6 ± 0.1 L/min, p < 0.05). Optimal AV/VV delays with left ventricle-preexcitation or simultaneous biventricular pacing caused additional increased CO from intrinsic rhythm by mean of 32.6% (3.8 ± 1.0 vs. 5.04 ± ± 1.0 L/min, p < 0.05). Optimal AV/VV setting delays also resulted in improved hemodynamic responses compared to VV factory setting delay. Conclusions: Both AV and VV delay optimization should be performed in clinical practice. Optimal AV delay improved outcome. However, combination of optimized AV/VV delays provided the best hemodynamic response. Optimized AV/VV delays with left ventricle-preexcitation or simultaneous biventricular pacing increased hemodynamic output compared to intrinsic rhythm and VV factory setting delay.
Development and advances in heart pacing over the last nearly half a century allowed to save nume... more Development and advances in heart pacing over the last nearly half a century allowed to save numerous lives by providing pacing support in bradycardia and complete heart block. Nevertheless, long-term follow up of patients with implanted pacemaker showed unfavorable remodeling of the heart, both from hemodynamic as well as electrical standpoint. The optimal programmed pacemaker setting, apart from the optimal place for ventricular stimulation, is essential to obtain the best hemodynamic and the clinical after-effects of the stimulation of the heart and to minimize potential unfavorable effects. In patients with dual-chamber pacemaker (DDD) the correct function of the left ventricle of the heart depends mainly on the electric delays between the stimulated chambers. Atrio-ventricular delay (AVD) during dual-chamber pacing influences left ventricle contraction function through preload modulation. Improperly programmed AVD in the DDD pacemaker can have unfavorable hemodynamic results. Various methods have been developed during last few decades (right heart catheterization, ventriculography, peak endocardial acceleration, echocardiography, and impedance cardiography), however only echocardiography and reocardiography are currently in general use. There should be noticed too, that also the application of special algorithms present in modern pacemakers allowing for dynamic changes of the time of the delay represents certain alternative to individual AVD optimization.
Annals of Noninvasive Electrocardiology, Mar 6, 2014
Background: The aim of this study was to ascertain whether individual atrioventricular delay (AVD... more Background: The aim of this study was to ascertain whether individual atrioventricular delay (AVD) optimization using impedance cardiography (ICG) offers beneficial hemodynamic effects as well as improved exercise tolerance and quality of life in patients with requiring constant right ventricular pacing. Methods: There were 37 patients with advanced AV block included in the study. Several examinations were performed at the beginning. Next, the optimization of AVD by ICG was done. The next step of the study patients have been randomized into optimal AVD group (AVDopt) or factory setting group (AVDfab). After 3 months, the follow-up all data were collected again and crossover was performed. After another 3 months, during the final follow-up all these measures were repeated. Results: In 87.5% patients, AVDopt were different than factory value. Cardiac output (CO), cardiac index (CI), and stroke volume (SV) were significantly (P < 0.001) higher in AVDopt group than in AVDfab group (CO: 6.0 ± 1.4 L/minute vs. 5.3 ± 1.2 L/minute; SV: 85.8 ± 25.7 mL vs.76.9 ± 22.5 mL; CI: 3.2 ± 0.7 L/minute/m 2 vs. 2.7 ± 0.6 L/minute/m 2). There was a statistical significant (P < 0.05) reduction of proBNP and NYHA class in patients with AVDopt compared to AVDfab (proBNP: 196.4 ± 144.7pg/mL vs. 269.4 ± 235.8 pg/mL; NYHA class: 1.7 ± 0.5 vs. 2.3 ± 0.6). Six-minute walking test was significantly (P < 0.05) higher in AVDopt group (409 ± 90 m) than in AVDfab group (362 ± 93 m). There were no statistically significant differences in echocardiographic parameters between AVDopt and AVDfab settings. Conclusion: Our study results suggest that AVD optimization in patients with DDD pacemaker with ICG improves hemodynamic when compared to the default factory settings. Furthermore, optimally programmed AVD reduces BNP and improves exercise tolerance and functional class.
Background: Twenty four hour Holter monitoring (HM) in an early post-implantation period in asymp... more Background: Twenty four hour Holter monitoring (HM) in an early post-implantation period in asymptomatic patients is considered as class IIb according to the ACC/AHA guidelines. It seems that post-implantation assessment extended by 24 hour HM in these patients might shorten hospitalization and increase safety of these patients. This aspect has not been widely discussed so far. The aim of our study was to evaluate pacing and sensing disturbances in asymptomatic patients with proper parameters of single and double chamber pacemakers. Methods: Studied group included 236 patients implanted with Biotronik Actros S (single chamber) (group I-130 patients) and Biotronik Actros D or Axios D (group II-106 patients) pacemakers. In all the patients 24 hour HM was performed 1-6 days after implantation (mean 3.4) in order to assess all pacing and sensing disturbances. Results: Sensing disturbances were found in 2 patients from group I and 22 patients from group II (the most frequent pacemaker failure was atrial undersensing followed by ventricular oversensing-T wave stering). In 1 patient from group I atrial failure to pace was observed. In whole group pacing/sensing disturbances were found in 23% of patients, nevertheless they did not provoke any hemodynamic consequences. Conclusions: In an early post-implantation period pacemaker disturbances occur in 23% of asymptomatic patients being more frequent in patients with dual chamber pacemaker. Atrial undersensing and ventricular oversensing are the most common disturbances, nevertheless having no hemodynamic consequences they are not life-threatening. Detection of these episodes in an early post-implantation period allows for early change in pacemakers' parameters and thus decreasing risk of rehospitalization. We confirmed the low usefulness of HM in patients with single chamber pacemaker early after implantation.
The population of patients with a pacemaker is constantly growing in number. Myocardial infarctio... more The population of patients with a pacemaker is constantly growing in number. Myocardial infarction in these patients, like in patients with left bundle branch block (LBBB), is called the undetermined type and characterizes the highest risk of death. Therefore the early and correct diagnosis of AMI is very important. The electrocardiographic criteria of the recognition of acute myocardial infarction (AMI) in patients with a ventricular pacing are similar to the electrocardiographic criteria of the recognition of AMI in patients with LBBB. They are applicable in the first phase of AMI’s diagnostic process and they are known as Sgarbossa’s criteria. However, one should remember about differences between these two groups of patients and therefore particular criteria have got different significance in patients from each group. There are three Sgarbossa’s criteria: ST-segment elevation of ≥ 5 mm in the presence of a negative QRS complex, ST-segment elevation of ≥ 1 mm in the presence of a...
The aim of the study was to explore the relationship between changes in pulse pressure (PP) and f... more The aim of the study was to explore the relationship between changes in pulse pressure (PP) and frequency domain heart rate variability (HRV) components caused by left ventricular pacing in patients with implanted cardiac resynchronization therapy (CRT). Material/Methods: Forty patients (mean age 63±8.5 years) with chronic heart failure (CHF) and implanted CRT were enrolled in the study. The simultaneous 5-minute recording of beat-to-beat arterial systolic and diastolic blood pressure (SBP and DBP) by Finometer and standard electrocardiogram with CRT switched off (CRT/0) and left ventricular pacing (CRT/LV) was performed. PP (PP=SBP-DBP) and low-and high-frequency (LF and HF) HRV components were calculated, and the relationship between these parameters was analyzed. Results: Short-term CRT/LV in comparison to CRT/0 caused a statistically significant increase in the values of PP (P<0.05), LF (P<0.05), and HF (P<0.05). A statistically significant correlation between DPP and DHF (R=0.7384, P<0.05) was observed. The DHF of 6 ms 2 during short-term CRT/LV predicted a PP increase of ³10% with 84.21% sensitivity and 85.71% specificity. Conclusions: During short-term left ventricular pacing in patients with CRT, a significant correlation between DPP and DHF was observed. DHF ³6 ms 2 may serve as a tool in the selection of a suitable site for placement of a left ventricular lead.
Background: Atrial fibrillation (AF) is the most common form of cardiac arrhythmia. A number of s... more Background: Atrial fibrillation (AF) is the most common form of cardiac arrhythmia. A number of studies have demonstrated that heart rate control is the first line therapy for patients with AF. However, the correct ventricular rate and the parameters to be assessed are still open to question. The aim of the study was to evaluate whether mean heart rate (mHR) in 24-hour ECG Holter monitoring (HM) is useful parameter for the assessment of ventricular rhythm control in patients with AF. Additionally, we investigated whether other parameters such as episodes of tachy AF, irregularity of rhythm and the patient's awareness of "palpitations" play an important role in controlling ventricular rate in AF. Methods: Patients with chronic brady-tachy AF who had undergone VVI pacemaker implantation between 2 and 9 days earlier (a mean of 5.6 days previously) with optimal pharmacotherapy and mHR below 90 bpm were enrolled in this study. The studied parameters included mHR and the coefficient of irregularity (CI), based on HM and the percentage of fast ventricular rates (tachy AF episodes defined as a heart rate of > 120 bpm) derived from the pacemaker memory data. Symptoms such as "palpitations" were marked with a "+" over a period of 24 hours. Results: Forty two patients (18 male, 24 female) with a mean age of 70.2 ± 8 years were included in the study. Their mHR in HM ranged from 48 bpm to 79 bpm, with a mean of 64.8 ± ± 7.5 bpm. Despite of a correct mHR, in 21 patients (50%) tachy AF episodes were observed. accounting for 1% to 8% beats, with a mean of 2.7 ± 2.02%. CI in HM varied from 0.9 to 0.33 with a mean of 0.23 ± 0.06. Significant irregularity, a CI above 0.2, together with a correct mHR was found in 73% patients. In the majority of patients with a low CI of < 0.2 (10 out of 11) there were no tachy AF episodes. A significant CI (> 0.2) was found in 10 out of 18 patients (56%) with a correct mHR and without tachy AF episodes. Palpitations were noted in 16 out of 21 patients with the correct mHR who had tachy AF episodes and 9 out of 10, also with the correct mHR, in whom no such episodes were recorded. All these patients had a significant ventricular rate irregularity with a CI of > 0.2. Conclusions: The parameter of mHR derived from HM is not sufficient for controlling ventricular rate in the majority of patients with brady-tachy AF. It seems that evaluating tachy Editorial p. 443 474
Background & objectives: The clinical benefit of optimization (OPT) of atrioventricular delay (AV... more Background & objectives: The clinical benefit of optimization (OPT) of atrioventricular delay (AVD) and interventricular delay (VVD) in cardiac resynchronization therapy (CRT) remains debatable. This study was aimed to determine the influence of AVD and VVD OPT on selected parameters in patients early after CRT implantation and at mid-term follow up (FU). Methods: Fifty two patients (61±10 yr, 23 males) with left bundle branch block, left ventricular ejection fraction (LVEF) ≤35 per cent and heart failure were selected for CRT implantation. Early on the second day (2DFU) after CRT implantation, the patients were assigned to the OPT or the factory setting (FS) group. Haemodynamic and electrical parameters were evaluated at baseline, on 2DFU after CRT and mid-term FU [three-month FU (3MFU)]. Echocardiographic measures were assessed before implantation and at 3MFU. The AVD/VVD was deemed optimal for the highest cardiac output (CO) with impedance cardiography (ICG) monitoring. Results: On 2DFU, the AVD was shorter in the OPT group, LV was paced earlier than in FS group and CO was insignificantly higher in OPT group. At 3MFU, improvement of CO was observed only in OPT patients, but the intergroup difference was not significant. At 3MFU in OPT group, reduction of LV in terms of LV end-diastolic diameter (LVeDD), LV end-systolic diameter, LV end-diastolic and systolic volume with the improvement in LVEF was observed. In FS group, only a reduction in LVeDD was present. In OPT group, the paced QRS duration was shorter than in FS group patients. Interpretation & conclusions: CRT OPT of AVD and VVD with ICG was associated with a higher CO and better reverse LV remodelling. CO monitoring with ICG is a simple, non-invasive tool to optimize CRT devices.
Background: Twenty four hour Holter monitoring (HM) in an early post-implantation period in asymp... more Background: Twenty four hour Holter monitoring (HM) in an early post-implantation period in asymptomatic patients is considered as class IIb according to the ACC/AHA guidelines. It seems that post-implantation assessment extended by 24 hour HM in these patients might shorten hospitalization and increase safety of these patients. This aspect has not been widely discussed so far. The aim of our study was to evaluate pacing and sensing disturbances in asymptomatic patients with proper parameters of single and double chamber pacemakers. Methods: Studied group included 236 patients implanted with Biotronik Actros S (single chamber) (group I-130 patients) and Biotronik Actros D or Axios D (group II-106 patients) pacemakers. In all the patients 24 hour HM was performed 1-6 days after implantation (mean 3.4) in order to assess all pacing and sensing disturbances. Results: Sensing disturbances were found in 2 patients from group I and 22 patients from group II (the most frequent pacemaker failure was atrial undersensing followed by ventricular oversensing-T wave stering). In 1 patient from group I atrial failure to pace was observed. In whole group pacing/sensing disturbances were found in 23% of patients, nevertheless they did not provoke any hemodynamic consequences. Conclusions: In an early post-implantation period pacemaker disturbances occur in 23% of asymptomatic patients being more frequent in patients with dual chamber pacemaker. Atrial undersensing and ventricular oversensing are the most common disturbances, nevertheless having no hemodynamic consequences they are not life-threatening. Detection of these episodes in an early post-implantation period allows for early change in pacemakers' parameters and thus decreasing risk of rehospitalization. We confirmed the low usefulness of HM in patients with single chamber pacemaker early after implantation.
Background: It has been reported that bifocal pacing (BiF) in the right ventricle might be an alt... more Background: It has been reported that bifocal pacing (BiF) in the right ventricle might be an alternative to unsuccessful left ventricular lead implantation. This case report presents an assessment of the clinical and hemodynamic parameters during a three month follow-up in patients implanted with right ventricular BiF. Methods: Eight patients who underwent unsuccessful left ventricular lead implantation were implanted with a bifocal system in the right ventricular. Leads were implanted in the right atrium appendage, the apex and the right ventricular outflow tract and connected to the cardiac resynchronization therapy pacemaker. All patients performed a sixminute walking test and underwent echocardiography after the implantation and after the three month follow-up. Results: We found a significant performance increase in the six minute walking test and reduction in New York Heart Association class and mitral regurgitation in echocardiography study, as well as a significant increase in left ventricular ejection fraction, and cardiac output directly after the implantation, as well as at threemonth follow-up in patients after BiF implantation. Conclusions: Right ventricular bifocal pacing in patients with cardiac resynchronization therapy indication and unsuccessful left ventricular lead placement seems to be a beneficial treatment for heart failure. Satisfactory hemodynamic and clinical results were observed directly after BiF implantation and during the three month follow-up.
The population of patients with a pacemaker is constantly growing in number. Myocardial infarctio... more The population of patients with a pacemaker is constantly growing in number. Myocardial infarction in these patients, like in patients with left bundle branch block (LBBB), is called the undetermined type and characterizes the highest risk of death. Therefore the early and correct diagnosis of AMI is very important. The electrocardiographic criteria of the recognition of acute myocardial infarction (AMI) in patients with a ventricular pacing are similar to the electrocardiographic criteria of the recognition of AMI in patients with LBBB. They are applicable in the first phase of AMI's diagnostic process and they are known as Sgarbossa's criteria. However, one should remember about differences between these two groups of patients and therefore particular criteria have got different significance in patients from each group. There are three Sgarbossa's criteria: ST-segment elevation of >/= 5 mm in the presence of a negative QRS complex, ST-segment elevation of >/= 1 mm in the presence of a positive QRS complex and ST-segment depression of >/= 1 mm in lead V1, V2 or V3. In spite of all limitations of use ECG records in the recognition of AMI in patients with a ventricular pacing it should be remembered, that this method (together with a typical medical history) is still the simplest, the cheapest and the most available means of an early diagnosis of AMI. In patients with chest pain, the presence of a pacemaker should not defer the execution of ECG recording because ECG may be very helpful in establishing of the diagnosis. (Cardiol J 2007; 14: 207-213).
Introduction: There is no consensus on the length of ECG tracing that should be recorded to repre... more Introduction: There is no consensus on the length of ECG tracing that should be recorded to represent adequate rate control in patients with atrial fibrillation (AFib). The purpose of the study was to examine whether heart rate measurements based on short-term ECGs recorded at different periods of the day may correspond to the mean heart rate and rate irregularity analyzed from standard 24-hour Holter monitoring. Material and methods: The study enrolled 50 consecutive patients with chronic AFib who underwent 24-hour Holter monitoring. Mean heart rate (mHR) and the coefficient of irregularity (CI) were assessed from 5-and 60-minute intervals of Holter recordings in different periods of the day. Results: The highest correlation in mean heart rate interval within 24 h was found during a 6-hour sample and in the periods 11.00 AM-12.00 PM, 12 PM-1.00 PM, and 1.00 PM-2.00 PM. With respect to irregularity, only the CI measurements based on a 6-hour interval (7.00 AM-1.00 AM) show a correlation > 0.08 compared to data from the 24-hour recording. Conclusions: Only long-term (6-hour) recordings provide a high correlation within 24 h in mean heart rate interval and coefficient of irregularity. It seems that the mean heart rate interval in 1-hour periods between 11 AM and 2 PM might be predictive for 24-hour data. Short time recordings of the coefficient of irregularity of heart rate in AFib patients at this moment are not useful in clinical practice for long-term prognosis of ventricular irregularity.
Background: Atrial fibrillation (AF) is the most common form of cardiac arrhythmia. A number of s... more Background: Atrial fibrillation (AF) is the most common form of cardiac arrhythmia. A number of studies have demonstrated that heart rate control is the first line therapy for patients with AF. However, the correct ventricular rate and the parameters to be assessed are still open to question. The aim of the study was to evaluate whether mean heart rate (mHR) in 24-hour ECG Holter monitoring (HM) is useful parameter for the assessment of ventricular rhythm control in patients with AF. Additionally, we investigated whether other parameters such as episodes of tachy AF, irregularity of rhythm and the patient's awareness of "palpitations" play an important role in controlling ventricular rate in AF. Methods: Patients with chronic brady-tachy AF who had undergone VVI pacemaker implantation between 2 and 9 days earlier (a mean of 5.6 days previously) with optimal pharmacotherapy and mHR below 90 bpm were enrolled in this study. The studied parameters included mHR and the coefficient of irregularity (CI), based on HM and the percentage of fast ventricular rates (tachy AF episodes defined as a heart rate of > 120 bpm) derived from the pacemaker memory data. Symptoms such as "palpitations" were marked with a "+" over a period of 24 hours. Results: Forty two patients (18 male, 24 female) with a mean age of 70.2 ± 8 years were included in the study. Their mHR in HM ranged from 48 bpm to 79 bpm, with a mean of 64.8 ± ± 7.5 bpm. Despite of a correct mHR, in 21 patients (50%) tachy AF episodes were observed. accounting for 1% to 8% beats, with a mean of 2.7 ± 2.02%. CI in HM varied from 0.9 to 0.33 with a mean of 0.23 ± 0.06. Significant irregularity, a CI above 0.2, together with a correct mHR was found in 73% patients. In the majority of patients with a low CI of < 0.2 (10 out of 11) there were no tachy AF episodes. A significant CI (> 0.2) was found in 10 out of 18 patients (56%) with a correct mHR and without tachy AF episodes. Palpitations were noted in 16 out of 21 patients with the correct mHR who had tachy AF episodes and 9 out of 10, also with the correct mHR, in whom no such episodes were recorded. All these patients had a significant ventricular rate irregularity with a CI of > 0.2. Conclusions: The parameter of mHR derived from HM is not sufficient for controlling ventricular rate in the majority of patients with brady-tachy AF. It seems that evaluating tachy Editorial p. 443 474
Background: Biventricular pacing has demonstrated benefit for patients with congestive heart fail... more Background: Biventricular pacing has demonstrated benefit for patients with congestive heart failure although in 5-15% unsuccessful left ventricular lead implantation is reported. Alternative for failed transvenous left ventricular implantation is epicardiac approach with thoracotomy. Unfortunately this method is associated with very serious complications. Additionally this method increases the costs of the procedures and is available in cardiosurgery units only. It is reported that bifocal pacing in right ventricle might be alternative for unsuccessful left ventricular lead (LVlead) implantation. The aim of the study was clinical and hemodynamic assessment, during 3 month follow up (3mFU) of patients in which bifocal pacing (BiF) in right ventricle was used, for a standard transvenous BiV procedures proved to be ineffective or unsatisfactory. Material and methods: The eight patients with mean age 65 ± 9, in NYHA IV, with LVEF = = 22%, mean QRS duration = 180 ms with failed LVlead implantation were included to the study. In all patients leads in right atrium appendage and to the apex and outflow tract of the right ventricle were implanted and connected to the Stratos LV pacemaker (PM) Results: In patients after BiF implantation significant increase in 6 minute walking test was reported. There was no significant difference in QRS duration after procedure. Significant reduction in intraventricular mechanical delay, left ventricular systolic diameter and increase in EF, cardiac output and cardiac index in patients with BiF in ECHO study was assessed.
The aim of the study was to explore the relationship between changes in pulse pressure (PP) and f... more The aim of the study was to explore the relationship between changes in pulse pressure (PP) and frequency domain heart rate variability (HRV) components caused by left ventricular pacing in patients with implanted cardiac resynchronization therapy (CRT). Material/Methods: Forty patients (mean age 63±8.5 years) with chronic heart failure (CHF) and implanted CRT were enrolled in the study. The simultaneous 5-minute recording of beat-to-beat arterial systolic and diastolic blood pressure (SBP and DBP) by Finometer and standard electrocardiogram with CRT switched off (CRT/0) and left ventricular pacing (CRT/LV) was performed. PP (PP=SBP-DBP) and low-and high-frequency (LF and HF) HRV components were calculated, and the relationship between these parameters was analyzed. Results: Short-term CRT/LV in comparison to CRT/0 caused a statistically significant increase in the values of PP (P<0.05), LF (P<0.05), and HF (P<0.05). A statistically significant correlation between DPP and DHF (R=0.7384, P<0.05) was observed. The DHF of 6 ms 2 during short-term CRT/LV predicted a PP increase of ³10% with 84.21% sensitivity and 85.71% specificity. Conclusions: During short-term left ventricular pacing in patients with CRT, a significant correlation between DPP and DHF was observed. DHF ³6 ms 2 may serve as a tool in the selection of a suitable site for placement of a left ventricular lead.
I In nt tr ro od du uc ct ti io on n: : We sought to determine the usefulness of ambulatory 24-ho... more I In nt tr ro od du uc ct ti io on n: : We sought to determine the usefulness of ambulatory 24-hour Holter monitoring in detecting asymptomatic pacemaker (PM) malfunction episodes in patients with dual-chamber pacemakers whose pacing and sensing parameters were proper, as seen in routine post-implantation follow-ups. M Ma at te er ri ia al l a an nd d m me et th ho od ds s: : Ambulatory 24-hour Holter recordings (HM) were performed in 100 patients with DDD pacemakers 1 day after the implantation. Only asymptomatic patients with proper pacing and sensing parameters (assessed on PM telemetry on the first day post-implantation) were enrolled in the study. The following parameters were assessed: failure to pace, failure to sense (both oversensing and undersensing episodes) as well as the percentage of all PM disturbances. R Re es su ul lt ts s: : Despite proper sensing and pacing parameters, HM revealed PM disturbances in 23 patients out of 100 (23%). Atrial undersensing episodes were found in 12 patients (p < 0.005) with totally 963 episodes and failure to capture in 1 patient (1%). T wave oversensing was the most common ventricular channel disorder (1316 episodes in 9 patients, p < 0.0005). Malfunction episodes occurred sporadically, leading to pauses of up to 1.6 s or temporary bradycardia, which were, nevertheless, not accompanied by clinical symptoms. No ventricular pacing disturbances were found. C Co on nc cl lu us si io on ns s: : Asymptomatic pacemaker dysfunction may be observed in nearly 25% of patients with proper DDD parameters after implantation. Thus, ambulatory HM during the early post-implantation period may be a useful tool to detect the need to reprogram PM parameters. K Ke ey y w wo or rd ds s: : DDD pacemaker, ambulatory Holter monitoring, pacemaker dysfunction. C Co or rr re es sp po on nd di in ng g a au ut th ho or r: :
Background: Biventricular pacing has demonstrated benefit for patients with congestive heart fail... more Background: Biventricular pacing has demonstrated benefit for patients with congestive heart failure although in 5-15% unsuccessful left ventricular lead implantation is reported. Alternative for failed transvenous left ventricular implantation is epicardiac approach with thoracotomy. Unfortunately this method is associated with very serious complications. Additionally this method increases the costs of the procedures and is available in cardiosurgery units only. It is reported that bifocal pacing in right ventricle might be alternative for unsuccessful left ventricular lead (LVlead) implantation. The aim of the study was clinical and hemodynamic assessment, during 3 month follow up (3mFU) of patients in which bifocal pacing (BiF) in right ventricle was used, for a standard transvenous BiV procedures proved to be ineffective or unsatisfactory. Material and methods: The eight patients with mean age 65 ± 9, in NYHA IV, with LVEF = = 22%, mean QRS duration = 180 ms with failed LVlead implantation were included to the study. In all patients leads in right atrium appendage and to the apex and outflow tract of the right ventricle were implanted and connected to the Stratos LV pacemaker (PM) Results: In patients after BiF implantation significant increase in 6 minute walking test was reported. There was no significant difference in QRS duration after procedure. Significant reduction in intraventricular mechanical delay, left ventricular systolic diameter and increase in EF, cardiac output and cardiac index in patients with BiF in ECHO study was assessed.
Background: Device optimization is not routinely performed in patients who underwent cardiac resy... more Background: Device optimization is not routinely performed in patients who underwent cardiac resynchronization therapy (CRT) device implantation. Noninvasive optimization of CRT devices by measurement of cardiac output (CO) can be used as a simple method to assess ventricular systolic performance. The aim of this study was to assess whether optimization of atrioventricular (AV) and interventricular (VV) delay can improve hemodynamic response to CRT and whether this optimization should be performed for each patient individually. Methods: Twenty patients with advanced heart failure New York Heart Association (NYHA) class III/IV, left ventricular ejection fraction ≤ 35% and left bundle branch block (QRS ≥ 120 ms) in sinus rhythm were evaluated from 24 h to 48 h after implantation of a CRT device by means of impedance cardiography (ICG). CO was fi rst measured at each patient's intrinsic rhythm. Patients then underwent adjustments of AV and VV delay from 80 ms to 140 ms and from-60 ms to +60 ms, respectively in 20 ms increment steps and CO at each setting was measured by ICG. Both AV and VV delays were programmed according to the greatest improvement in CO compared to intrinsic rhythm. Results: There was a statistically signifi cant increase in CO measured at the intrinsic rhythm compared to different AV delay by mean of 21% (3.8 ± 1.0 vs. 4.6 ± 0.1 L/min, p < 0.05). Optimal AV/VV delays with left ventricle-preexcitation or simultaneous biventricular pacing caused additional increased CO from intrinsic rhythm by mean of 32.6% (3.8 ± 1.0 vs. 5.04 ± ± 1.0 L/min, p < 0.05). Optimal AV/VV setting delays also resulted in improved hemodynamic responses compared to VV factory setting delay. Conclusions: Both AV and VV delay optimization should be performed in clinical practice. Optimal AV delay improved outcome. However, combination of optimized AV/VV delays provided the best hemodynamic response. Optimized AV/VV delays with left ventricle-preexcitation or simultaneous biventricular pacing increased hemodynamic output compared to intrinsic rhythm and VV factory setting delay.
Development and advances in heart pacing over the last nearly half a century allowed to save nume... more Development and advances in heart pacing over the last nearly half a century allowed to save numerous lives by providing pacing support in bradycardia and complete heart block. Nevertheless, long-term follow up of patients with implanted pacemaker showed unfavorable remodeling of the heart, both from hemodynamic as well as electrical standpoint. The optimal programmed pacemaker setting, apart from the optimal place for ventricular stimulation, is essential to obtain the best hemodynamic and the clinical after-effects of the stimulation of the heart and to minimize potential unfavorable effects. In patients with dual-chamber pacemaker (DDD) the correct function of the left ventricle of the heart depends mainly on the electric delays between the stimulated chambers. Atrio-ventricular delay (AVD) during dual-chamber pacing influences left ventricle contraction function through preload modulation. Improperly programmed AVD in the DDD pacemaker can have unfavorable hemodynamic results. Various methods have been developed during last few decades (right heart catheterization, ventriculography, peak endocardial acceleration, echocardiography, and impedance cardiography), however only echocardiography and reocardiography are currently in general use. There should be noticed too, that also the application of special algorithms present in modern pacemakers allowing for dynamic changes of the time of the delay represents certain alternative to individual AVD optimization.
Annals of Noninvasive Electrocardiology, Mar 6, 2014
Background: The aim of this study was to ascertain whether individual atrioventricular delay (AVD... more Background: The aim of this study was to ascertain whether individual atrioventricular delay (AVD) optimization using impedance cardiography (ICG) offers beneficial hemodynamic effects as well as improved exercise tolerance and quality of life in patients with requiring constant right ventricular pacing. Methods: There were 37 patients with advanced AV block included in the study. Several examinations were performed at the beginning. Next, the optimization of AVD by ICG was done. The next step of the study patients have been randomized into optimal AVD group (AVDopt) or factory setting group (AVDfab). After 3 months, the follow-up all data were collected again and crossover was performed. After another 3 months, during the final follow-up all these measures were repeated. Results: In 87.5% patients, AVDopt were different than factory value. Cardiac output (CO), cardiac index (CI), and stroke volume (SV) were significantly (P < 0.001) higher in AVDopt group than in AVDfab group (CO: 6.0 ± 1.4 L/minute vs. 5.3 ± 1.2 L/minute; SV: 85.8 ± 25.7 mL vs.76.9 ± 22.5 mL; CI: 3.2 ± 0.7 L/minute/m 2 vs. 2.7 ± 0.6 L/minute/m 2). There was a statistical significant (P < 0.05) reduction of proBNP and NYHA class in patients with AVDopt compared to AVDfab (proBNP: 196.4 ± 144.7pg/mL vs. 269.4 ± 235.8 pg/mL; NYHA class: 1.7 ± 0.5 vs. 2.3 ± 0.6). Six-minute walking test was significantly (P < 0.05) higher in AVDopt group (409 ± 90 m) than in AVDfab group (362 ± 93 m). There were no statistically significant differences in echocardiographic parameters between AVDopt and AVDfab settings. Conclusion: Our study results suggest that AVD optimization in patients with DDD pacemaker with ICG improves hemodynamic when compared to the default factory settings. Furthermore, optimally programmed AVD reduces BNP and improves exercise tolerance and functional class.
Background: Twenty four hour Holter monitoring (HM) in an early post-implantation period in asymp... more Background: Twenty four hour Holter monitoring (HM) in an early post-implantation period in asymptomatic patients is considered as class IIb according to the ACC/AHA guidelines. It seems that post-implantation assessment extended by 24 hour HM in these patients might shorten hospitalization and increase safety of these patients. This aspect has not been widely discussed so far. The aim of our study was to evaluate pacing and sensing disturbances in asymptomatic patients with proper parameters of single and double chamber pacemakers. Methods: Studied group included 236 patients implanted with Biotronik Actros S (single chamber) (group I-130 patients) and Biotronik Actros D or Axios D (group II-106 patients) pacemakers. In all the patients 24 hour HM was performed 1-6 days after implantation (mean 3.4) in order to assess all pacing and sensing disturbances. Results: Sensing disturbances were found in 2 patients from group I and 22 patients from group II (the most frequent pacemaker failure was atrial undersensing followed by ventricular oversensing-T wave stering). In 1 patient from group I atrial failure to pace was observed. In whole group pacing/sensing disturbances were found in 23% of patients, nevertheless they did not provoke any hemodynamic consequences. Conclusions: In an early post-implantation period pacemaker disturbances occur in 23% of asymptomatic patients being more frequent in patients with dual chamber pacemaker. Atrial undersensing and ventricular oversensing are the most common disturbances, nevertheless having no hemodynamic consequences they are not life-threatening. Detection of these episodes in an early post-implantation period allows for early change in pacemakers' parameters and thus decreasing risk of rehospitalization. We confirmed the low usefulness of HM in patients with single chamber pacemaker early after implantation.
The population of patients with a pacemaker is constantly growing in number. Myocardial infarctio... more The population of patients with a pacemaker is constantly growing in number. Myocardial infarction in these patients, like in patients with left bundle branch block (LBBB), is called the undetermined type and characterizes the highest risk of death. Therefore the early and correct diagnosis of AMI is very important. The electrocardiographic criteria of the recognition of acute myocardial infarction (AMI) in patients with a ventricular pacing are similar to the electrocardiographic criteria of the recognition of AMI in patients with LBBB. They are applicable in the first phase of AMI’s diagnostic process and they are known as Sgarbossa’s criteria. However, one should remember about differences between these two groups of patients and therefore particular criteria have got different significance in patients from each group. There are three Sgarbossa’s criteria: ST-segment elevation of ≥ 5 mm in the presence of a negative QRS complex, ST-segment elevation of ≥ 1 mm in the presence of a...
The aim of the study was to explore the relationship between changes in pulse pressure (PP) and f... more The aim of the study was to explore the relationship between changes in pulse pressure (PP) and frequency domain heart rate variability (HRV) components caused by left ventricular pacing in patients with implanted cardiac resynchronization therapy (CRT). Material/Methods: Forty patients (mean age 63±8.5 years) with chronic heart failure (CHF) and implanted CRT were enrolled in the study. The simultaneous 5-minute recording of beat-to-beat arterial systolic and diastolic blood pressure (SBP and DBP) by Finometer and standard electrocardiogram with CRT switched off (CRT/0) and left ventricular pacing (CRT/LV) was performed. PP (PP=SBP-DBP) and low-and high-frequency (LF and HF) HRV components were calculated, and the relationship between these parameters was analyzed. Results: Short-term CRT/LV in comparison to CRT/0 caused a statistically significant increase in the values of PP (P<0.05), LF (P<0.05), and HF (P<0.05). A statistically significant correlation between DPP and DHF (R=0.7384, P<0.05) was observed. The DHF of 6 ms 2 during short-term CRT/LV predicted a PP increase of ³10% with 84.21% sensitivity and 85.71% specificity. Conclusions: During short-term left ventricular pacing in patients with CRT, a significant correlation between DPP and DHF was observed. DHF ³6 ms 2 may serve as a tool in the selection of a suitable site for placement of a left ventricular lead.
Background: Atrial fibrillation (AF) is the most common form of cardiac arrhythmia. A number of s... more Background: Atrial fibrillation (AF) is the most common form of cardiac arrhythmia. A number of studies have demonstrated that heart rate control is the first line therapy for patients with AF. However, the correct ventricular rate and the parameters to be assessed are still open to question. The aim of the study was to evaluate whether mean heart rate (mHR) in 24-hour ECG Holter monitoring (HM) is useful parameter for the assessment of ventricular rhythm control in patients with AF. Additionally, we investigated whether other parameters such as episodes of tachy AF, irregularity of rhythm and the patient's awareness of "palpitations" play an important role in controlling ventricular rate in AF. Methods: Patients with chronic brady-tachy AF who had undergone VVI pacemaker implantation between 2 and 9 days earlier (a mean of 5.6 days previously) with optimal pharmacotherapy and mHR below 90 bpm were enrolled in this study. The studied parameters included mHR and the coefficient of irregularity (CI), based on HM and the percentage of fast ventricular rates (tachy AF episodes defined as a heart rate of > 120 bpm) derived from the pacemaker memory data. Symptoms such as "palpitations" were marked with a "+" over a period of 24 hours. Results: Forty two patients (18 male, 24 female) with a mean age of 70.2 ± 8 years were included in the study. Their mHR in HM ranged from 48 bpm to 79 bpm, with a mean of 64.8 ± ± 7.5 bpm. Despite of a correct mHR, in 21 patients (50%) tachy AF episodes were observed. accounting for 1% to 8% beats, with a mean of 2.7 ± 2.02%. CI in HM varied from 0.9 to 0.33 with a mean of 0.23 ± 0.06. Significant irregularity, a CI above 0.2, together with a correct mHR was found in 73% patients. In the majority of patients with a low CI of < 0.2 (10 out of 11) there were no tachy AF episodes. A significant CI (> 0.2) was found in 10 out of 18 patients (56%) with a correct mHR and without tachy AF episodes. Palpitations were noted in 16 out of 21 patients with the correct mHR who had tachy AF episodes and 9 out of 10, also with the correct mHR, in whom no such episodes were recorded. All these patients had a significant ventricular rate irregularity with a CI of > 0.2. Conclusions: The parameter of mHR derived from HM is not sufficient for controlling ventricular rate in the majority of patients with brady-tachy AF. It seems that evaluating tachy Editorial p. 443 474
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