Pacing and clinical electrophysiology : PACE
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Pacing Clin Electrophysiol · Jun 2000
Safety of pacemaker implantation prior to radiofrequency ablation of atrioventricular junction in a single session procedure.
RF current delivery may cause acute and chronic dysfunction of previously implanted pacemakers. The aim of this study was to assess prospectively the effects of RF energy on Thera I and Kappa pacemakers in 70 consecutive patients (mean age 70 +/- 11 years, mean left ventricular ejection fraction 48 +/- 15%) who underwent RF ablation of the AV junction for antiarrhythmic drug refractory atrial fibrillation (permanent in 42 patients, paroxysmal in 28). These pacing systems incorporate protection elements to avoid electromagnetic interference. ⋯ In conclusion, Thera I and Kappa pacemakers exhibit excellent protection against interference produced by RF current. The functional integrity of the pacemakers and Capsure leads was observed in the acute and chronic phases. Thus, the implantation of these pacing systems prior to RF ablation of the AV junction can be recommended.
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Pacing Clin Electrophysiol · Jun 2000
Assessment of autonomic nervous system functions in patients with vitamin B12 deficiency by power spectral analysis of heart rate variability.
The purpose of this study was to test the autonomic nervous system function of patients with vitamin B12 deficiency (megaloblastic anemia) by measuring heart rate variability (HRV). The study population consisted of 17 vitamin B12 deficient patients and 15 age- and sex-matched normal volunteers. HRV was measured by power spectral analysis from which power of the low frequency (LF) peak (0.04-0.15 Hz), normalized units of the LF peak (LFNU), power of the high frequency (HF) peak (0.15-0.4 Hz), normalized units of the HF (HFNU), and ratio of power of LF to power of HF (LF:HF) were calculated. ⋯ All HRV parameters correlated positively with the level of vitamin B12 (P < 0.001) and negatively with the duration of disease (P < 0.001). After vitamin B12 replacement the HRV parameters of patients and controls became comparable (P > 0.05). Our data suggest that autonomic sympathetic and parasympathetic nervous activities are decreased in patients with vitamin B12 deficiency, an abnormality that can be corrected by vitamin B12 replacement therapy.
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Pacing Clin Electrophysiol · Jun 2000
Assessing the psychosocial impact of the ICD: a national survey of implantable cardioverter defibrillator health care providers.
The implantable cardioverter defibrillator (ICD) provides a survival advantage over antiarrhythmic medications for patients with life-threatening ventricular arrhythmias. However, the effect of ICD therapy on quality-of-life and psychosocial functioning are not as well understood. Health care providers (e.g., physicians, nurses) can serve as a valuable source of information related to these ICD outcomes. ⋯ Significant differences were noted between physicians and nurses/other health care professionals on a wide range of psychosocial issues. Health care providers generally reported the most comfort dealing with traditional medical issues (i.e., patient adherence), and the least comfort in managing emotional well-being issues (e.g., depression and anxiety). These results suggest that routine attention to ICD quality-of-life and psychosocial outcomes is indicated for health care providers who care for ICD recipients.
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Pacing Clin Electrophysiol · May 2000
Case ReportsSuccessful treatment of idiopathic left ventricular outflow tract tachycardia by catheter ablation or minimally invasive surgical cryoablation.
Idiopathic right ventricular outflow tract tachycardia is readily amenable to radiofrequency catheter ablation. However, treatment modalities for left ventricular outflow tract tachycardia are not well defined. Out of 37 patients with idiopathic outflow tract tachycardia referred for catheter ablation, in 3 patients tachycardia originated from the left ventricular outflow tract. ⋯ During a follow-up period ranging from 7 to 12 months, all patients remained free of tachycardia. In conclusion, ventricular tachycardia arising from the left ventricular outflow tract may require endo- and epicardial mapping. Successful treatment is achieved by radiofrequency catheter ablation or minimally invasive surgical cryoablation.
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Pacing Clin Electrophysiol · May 2000
Age dependency of sensing performance and AV synchrony in single lead VDD pacing.
Implantation of single lead VDD pacemakers is an established therapeutic option in patients with AV block and normal sinus node function. However, related to occurrence of sinus node disease and atrial undersensing, there is concern whether VDD devices are appropriate in physically active young patients. Two hundred thirty-two consecutive patients with isolated AV block and VDD pacemakers were investigated. ⋯ Atrial arrhythmias and loss of AV synchronized pacing mode occurred rarely in young patients: 0.6% (0.4%) per year in group A versus 1.3% (1.3%) in group B, 3.9% (3.4%) in group C, and 5.7% (7.4%) per year in group D, P < 0.01 for intergroup comparisons. Our data show good atrial sensing performance, low incidence of sinus node dysfunction, and few atrial arrhythmias in young patients with VDD pacing for AV block. Thus, single lead VDD pacing can be recommended particularly for young patients with AV block.