Pacing and clinical electrophysiology : PACE
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Pacing Clin Electrophysiol · Jan 2009
Randomized Controlled TrialSpinal cord stimulation and 30-minute heart rate variability in refractory angina patients.
Spinal cord stimulation (SCS) has proven antianginal and antiischemic effects in severe coronary artery disease patients, minimizing frequency, intensity, and duration of pain. The mechanism explaining these effects has been detected in a sympathicolytic effect of the SCS. We monitored 30-minute-long recordings of the heart rate variability (HRV) and its spectral power parameters to evaluate the influence of SCS on the sympathetic/parasympathetic balance. ⋯ No difference emerged instead comparing OFF versus SUB (P = 0.575). The stimulation effect was not influenced by the randomized sequence. Thirty-minute SCS significantly influenced the sympathetic/parasympathetic balance reducing sympathetic modulation.
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Pacing Clin Electrophysiol · Jan 2009
Permanent pacemaker implantation following cardiac surgery: indications and long-term follow-up.
Conduction disturbances requiring permanent pacemaker implantation after heart surgery occur in about 1.5% of patients. Early pacemaker implantation may reduce morbidity and postoperative hospital stay. We reviewed our experience with patients undergoing surgery to try and identify predictors for pacemaker requirements and patients who will remain pacemaker dependent. ⋯ Patients at high risk for pacemaker implantation after heart surgery include those with preexisting conduction disturbances, and those undergoing aortic valve replacement. Of those receiving a pacemaker, about one-third will recover at late follow-up. For patients in the high-risk group who are pacemaker dependent after surgery, we recommend implanting a permanent pacemaker at 5 days after surgery, thus enabling early mobilization and early discharge.
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Mutations of the cardiac sodium channel gene, SCN5A, are present in both long-QT and Brugada syndromes. Flecainide is used as a provocative test to unmask the electrocardiogram (ECG) phenotype of the Brugada syndrome, as well as long-term treatment for long QT-3 syndrome, since it shortens the QT interval. We report a case where oral flecainide induced syncope with a Brugada ECG pattern in a patient with known long QT-3 syndrome.
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Pacing Clin Electrophysiol · Jan 2009
Systematic comparisons of electrocardiographic morphology increase the precision of QT interval measurement.
Decreased intrasubject variability of QTc values is needed to increase the power and reduce the size of the so-called thorough QT studies. One source of QTc variability is the lack of systematic measurements when electrocardiograms (ECG) with closely matching morphologies are not measured in an exactly corresponding way. The inaccuracy can be eliminated by postprocessing of QT measurements by ECG pattern matching. ⋯ Hence, morphological pattern adjustment of QT interval measurements improves the quality of the QT data with substantial practical implications. Reductions in intrasubject QTc variability were reproducibly found in different populations and thus the technology might be recommended for every thorough QT/QTc study. Noticeable reductions of necessary study size are likely achievable in this way.
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Twiddler's syndrome is classically described as withdrawal of pacing or defibrillator leads from their position in the heart as a result of arm motion or manipulation of the pulse generator site. Reverse Twiddler's syndrome is now reported as advancement of the leads into the heart by a similar repetitive motion but opposite in direction.