The Basis for Activity Controlled Rate Variable Cardiac Pacemakers: An Analysis of Mechanical Forces on the Human Body Induced by Exercise and Environment

We conducted tests on six healthy volunteers and six pacemaker patients. With the aid of three straight line frequency acceleration pickups attached to the body, the mechanical signals were recorded on the three axes during different activities. Along with standardized exercise on bicycle and treadmill ergometers, we tested the influence of household activities and interference influences. The results were analyzed in terms of the amplitude and frequency content of the signals. For walking activities, we found a signal amplitude increasing in a largely linear fashion with the walking speed, the signal amplitudes being approximately twice as high on the vertical axis as on the other two axes. Exercise on the bicycle ergometer produced mechanical signals of clearly lower amplitude than comparable walking activities. The Fast-Fourier analysis showed amplitude peaks in the low frequency range of 1 to 4 Hz for all forms of physiological exercise, while interference influences showed amplitude peaks mainly in the range above 8 Hz. The use of a straight line-frequency acceleration pickup and a corresponding low pass filter might be a way of reducing the effect of unphysiological interference influences on an activity controlled pacemaker system. A sensor measuring on the horizontal axis appears to be the most favorable compromise for the various types of exercise. However, due to the considerable difference in signal amplitude for different types of exercise of the same intensity, an activity controlled pacemaker system cannot entirely meet metabolic conditions and requirements.     

Temporal Relationship Between Exercise and QT Shortening in Patients with QT Pacemakers

The present study was undertaken to examine the temporal relationship between exercise and QT interval shortening as one of the principal determinants for the functioning of QT pacemakers. Ten patients (mean age of 72.6 years) with implanted QT pacemakers were subjected to supine bicycle exercise with two different slopes, 90% and 80%. The QT interval as seen by the pacemaker was monitored by telemetry and stored on magnetic tape. After the beginning of exercise QT prolongation of a few msec occurred up to 40 sec in most patients. The earliest QT shortening of 4 msec was noted after 63.4 sec with 90% slope and 75.7 sec with 80% slope. The difference was not significant. The further time course was dependent on slope and pacemaker algorithm. Maximal QT shortening was 65.9 msec with 90% and 69.8 msec with 80% slope. It was seen 29.2 sec after termination of exercise with 90% slope and 69.5 sec with 80% slope (P < 0.05). There was no correlation of the measured delays with age. Earliest rate response in QT driven pacemakers is determined by earliest QT shortening on one hand and by the slope setting of the pacemaker on the other, where the limiting parameter appears to be QT shortening, which occurs after the first minute of exercise.     

Lysis of pathogenic and nonpathogenic Entamoeba histolytica by human complement: methodological analysis

The effect of nonimmune human serum on Entamoeba histolytica trophozoites was studied: (a) using whole serum in the presence of Ca and Mg ions allowing complement activation via both the alternative and classical pathways or in the presence of MgEGTA permitting alternative pathway activation only; (b) using different E. histolytica isolates; (c) varying serum and trophozoite concentrations and the time of incubation; and (d) using three different methods to quantify lysis, i.e., microscopic inspection, flow cytometry and 111In release. All three methods yielded similar results, with flow cytometry being most sensitive in identifying membrane damage and 111In release being most valid in determining cell death. Microscopic analysis was reliable only when a chamber was used to calculate the number of complement treated cells in relation to the initial cell count. E. histolytica isolates were classified into three groups according to their susceptibility to lysis by complement: (i) pathogenic isolates after long term cultivation in vitro were susceptible; (ii) pathogenic isolates after recent in vivo passage were less susceptible; and (iii) nonpathogenic isolates were nearly unaffected by exposure to the alternative pathway alone. The extent of lysis of the various isolates correlated with the degree of complement consumption in the serum samples, suggesting that unlysed isolates did not activate complement under the conditions employed. In general, lysis of susceptible trophozoites increased with the serum concentration and with the time of incubation. However, when the trophozoite concentration was 10(6)/ml or higher, lysis no longer reflected complement susceptibility because of exhaustion of the complement supply.     

Internal Cardioversion of Atrial Fibrillation with a Single Lead Configuration in a Patient with Massive Diaphragmatic Herniation

An anatomically related circumstance is reported as indication for the internal low energy Cardioversion instead of an external approach. A new single lead electrode configuration is described.