Effect of atrial pacing therapy with selective pacing algorithms on paroxysmal atrial fibrillation

Atrial fibrillation (AF) is the most common cardiac arrhythmia among the elderly. Its incidence increases dramatically with increasing age and decreasing left ventrieular function, peaking in subjects with overt congestive heart failure, Because of the unsatisfactory efficacy and possible serious side effects of clinically available anti-AF drugs for AF patients with sick sinus syndrome, pacing techniques have recently been applied in the treatment of AF. The cardiac pacemaker Vitatron     

球囊漂浮电极床旁临时心脏起搏的临床评价

目的探讨球囊漂浮电极床旁心脏临时起搏方法的可行性。方法对216例因多种心律失常需要临时心脏起搏的患者应用球囊漂浮电极导管进行心脏临时起搏，通过分析起搏心电图图形特点和术中并发症，判断该起搏方法的可行性。结果216例患者穿刺及送管均获成功，无严重并发症发生。3例起搏后死于原发病，9例起搏后自身心律未恢复安置永久起搏器，2例心房颤动合并PR长间期患者起搏后安置永久起搏器，38例行预防起搏。结论在体表心电图的指导下应用球囊漂浮电极导管进行心脏临时起搏是一项安全有效、可行的起搏方法，操作简便、快捷、成功率高，值得临床广泛应用。     

Ventricular rate smoothing for atrial fibrillation: a quantitative comparison study.

AIMS: To quantitatively compare the ventricular rate-smoothing (VRS) effects of different ventricular pacing (VP) protocols for atrial fibrillation (AF). METHODS AND RESULTS: Using a recently developed open-source model that can simulate the ventricular response in AF and VP, the performance of fixed-rate pacing and four previously published VRS algorithms were assessed by the mean RR (mRR), the root mean square of successive RR differences (RMSSD), the percentage of ventricular senses (VS%), and the percentage of short RR intervals (sRR%). All pacing protocols cause rate-dependent reduction of RMSSD, VS%, and sRR% with or without shortening of mRR compared to spontaneous AF. Fixed-rate pacing was more sensitive to the intrinsic rate than the VRS algorithms. The performance was generally comparable between different VRS algorithms, although higher mRR and VS% can be achieved at the expense of larger RMSSD and sRR%. CONCLUSION: The effect of VP on ventricular rhythm in AF depends on both intrinsic rate and the aggressiveness of the pacing protocol. Adequate rate control is necessary for effective operation of the VRS algorithm. Choosing VRS algorithm should balance between the beneficial effects of rate regularization and the negative effects of increasing heart rate and percentage of VP.     

207例预激综合征的心律失常

对207例预激综合征行电生理检查.检出心律失常171例.占82.6%。房室折返性心动过速占所有心律失常的80.4%,心房颤动13.1%,其他6.5%.房室折返性心动过速占我院同期室上速的56.5%.远较房室结折返性心动过速(24.4%)多见。隐性旁路在室上速中占29%,居首位。上述情况反映我国人室上速的构成比可能与西方国家不同。     

西宁地区健康小儿窦房结功能测定的初步探讨

应用食道心房调博缩测定健康小儿窦房结功能，以了解西宁地区正常数值与平原地区进行对比。选择２７例健康小儿，将Ｆ６二级电极导管从鼻腔送入，定位地食道心电图最大正负双相Ｐ波处，采用苏州东方电子仪器厂生产的ＤＦ－３Ａ型心脏电生理治疗仪进行检查，从而作出诊断。     

A New Low Threshold Platinized Epicardial Pacing Electrode: Comparative Evaluation in Immature Canines

A prospective comparison of pacing and sensing capabilities between the conventional Medtronic Model 4951 platinum-iridium epicardial pacing electrode and a new modified "platinized" version of the same electrode was performed in immature canines to determine if the new electrode design improves pacing in the immature myocardium. The conventional electrode was modified by electroplating platinum black particles onto the surface to increase the effective or true microscopic surface area, yet essentially maintain the same overall geometric electrode size. Both epicardial electrodes were inserted into the right ventricular myocardium with the lead pad sutured to the epicardium, and externalized to the scruff in five puppies (age 3 months). An additional left ventricular lead was implanted to permit chronic pacing following epicardially-induced atrioventricular block. Acute and chronic sensing and pacing capabilities of each externalized electrode were performed at implant and weekly up to 4 months. Histologic examination of each electrode implant site was performed at the end of the study period. At implant, both electrodes exhibited comparable values for sensed R waves, lead impedances, and pacing thresholds. During the study, the platinized electrode exhibited lower pacing thresholds. Analysis of all postimplant data demonstrated this threshold difference to be significantly lower (P less than .01) for the platinized version. Lead impedance and sensing capabilities remained comparable between the two designs. Histologic study demonstrated less fibrotic infiltration at the platinized electrode site. This preliminary evaluation indicates that for the duration of the postimplant study period, the platinized epicardial electrode design was associated with significantly lower thresholds and less fibrosis as a function of time compared to the conventional smooth electrode surface design. The new platinized electrode limits exit block in the developing immature myocardium and permits safe pacing at lower pulse widths and voltages to increase battery life.     

Rate-responsive pacing with a pacemaker that detects respiratory rate (Biorate): clinical advantages and complications

The respiratory-dependent pacemaker (RDP3 or MB-1, Biorate, Biotec International, S.p.A., Bologna, Italy) detects the respiratory rate by measuring thoracic impedance using a subcutaneous auxiliary lead. The sensed respiratory rate is used to determine the pacing rate response. This pacemaker had been implanted in 9 patients with a mean age of 58 (range 42-69) years. During symptom-limited treadmill exercise, rate-modulated pacing resulted in a significant increase in pacing rate (mean +/- SD, 124 +/- 10 vs. 71 +/- 3 beats/min p less than 0.001) and exercise capacity (343 +/- 147 vs. 463 +/- 120 s, p less than 0.05) compared to those achieved with constant rate ventricular pacing. Brief treadmill exercise tests showed appropriate rate response to increased walking speed and gradient. However, rate response was modified by arm swinging-induced motion artefact which affected the measured "impedance." Complications observed on follow-up included perforation of the auxiliary lead in 2 patients and symptomatic myopotential interference in 3 patients with the RDP3 pacemaker, all of whom required unit replacement. It is concluded that although the respiratory-dependent pacemaker can confer physiological benefit in patients with bradycardia, myopotential interference (largely overcome by the new version MB-1 with programmable sensitivity) and the auxiliary lead can be problematic in some patients.     

Reliability of Transesophageal Pacing in the Assessment of Sinus Node Function in Patients with Sick Sinus Syndrome

The purpose of this study was to find out whether transesophageal pacing could be utilized for assessment of sinus node function in patients with sick sinus syndrome (SSS). In 17 patients with SSS (study group) we compared the results of sinus node tests obtained both in the basal state and after pharmacological autonomic blockade by endocavitary stimulation and, 24 hours later, by transesophageal pacing. In another group of 17 patients with SSS (control group), we compared the results obtained by two endocavitary studies. In "study group", sinus cycle length (SCL) and corrected sinus node recovery time (CSRT) did not show significant differences between the two studies both in the basal state and after autonomic blockade, whereas sinoatrial conduction time (SACT) was more prolonged during esophageal pacing (P less than 0.01). In "control group", sinus node measures did not show significant differences between the two studies. In the "study group," the following coefficients of correlation were obtained in the basal state; SCL, r = 0.65, CSRT, r = 0.57, SACT, r = 0.52 and after autonomic blockade: SCL, r = 0.95, CSRT, r = 0.62 and SACT, r = 0.53. In the basal state, the correlation for SCL and CSRT between the two studies was lower in the "study group" than in the "control group" (P less than 0.05), whereas after autonomic blockade the correlation for sinus node measures did not show significant differences between the two groups of patients. These data suggest that transesophageal study influences the autonomic tone regulating the sinus node; however, it is not responsible for important variations in sinus node measures.(ABSTRACT TRUNCATED AT 250 WORDS)     

Heart rate and body temperature sensitive diaphragm pacing

Two ways of rate control for diaphragm pacing are proposed. One is rate control using only the patients' body temperature (method I). The other is rate control by both the patients' heart rate and body temperature (method II). To test the effectiveness of these methods, a diaphragm pacemaker which can be controlled by both heart rate and body temperature has been developed. It was applied to nine mongrel dogs. The pacing rate is controlled by atrial blood temperature (method I) or by both heart rate and temperature (method II). The animal's metabolism was elevated by the administration of a pyrogenic drug. It was found that method I is not suited to rapid changes in metabolism; however, it is useful in extreme metabolic elevation. An animal's metabolism was supported by using method II in all ranges of metabolism. This method proved more effective than method I for rate-responsive diaphragm pacing.     

Entrainment of Intestinal Slow Waves with Electrical Stimulation Using Intraluminal Electrodes

The aim of this study was to investigate whether the intestinal stimulation would be feasible using a less invasive method: intraluminal electrodes. The study was performed in nine healthy hound dogs (15–26 kg). Four pairs of electrodes were implanted on the serosa of the jejunum at an interval of 5 cm with the most proximal pair 35 cm beyond the pylorus. An intestinal fistula was made 20 cm beyond the pylorus. Simultaneous recordings of intestinal myoelectrical activity were made for 2 h in the fasting state from both intraluminal and serosal electrodes. Various pacing parameters were tested. The frequency of the intestinal slow wave recorded from the intraluminal electrodes was identical to that from the serosal electrodes , p < 0.001), and so was the percentage of normal 17–22 cycles/min waves (95.8±33.9% vs 98.16±1.33%, r=0.96, p<0.01).p < 0.01). A complete entrainment of the intestinal slow wave was achieved in every dog with electrical stimulation using intraluminal ring electrodes. The effective pacing parameters were pulse width of 70 ms, amplitude of 4 mA and frequency of 1.1 IF (intrinsic frequency). The time required for the entrainment of the intestinal slow wave with intraluminal pacing was 25.0±2.1s. The maximum driven frequency was found to be 1.43±0.01 IF. The results reveal that intraluminal pacing is an effective and efficient method for the entrainment of intestinal slow waves. It may become a potential approach for the treatment of intestinal motor disorders associated with myoelectrical abnormalities. © 2000 Biomedical Engineering Society. PAC00: 8754Dt, 8719Ff, 8717Nn