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Dual Chamber ICDs (dual + chamber_icd)
Selected AbstractsMulticenter, Prospective, Randomized Safety and Efficacy Study of a New Atrial-Based Managed Ventricular Pacing Mode (MVP) in Dual Chamber ICDsJOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 8 2005MICHAEL O. SWEENEY M.D. Background: Ventricular desynchronization caused by right ventricular pacing may impair ventricular function and increase risk of heart failure (CHF), atrial fibrillation (AF), and death. Conventional DDD/R mode often results in high cumulative percentage ventricular pacing (Cum%VP). We hypothesized that a new managed ventricular pacing mode (MVP) would safely provide AAI/R pacing with ventricular monitoring and DDD/R during AV block (AVB) and reduce Cum%VP compared to DDD/R. Methods: MVP RAMware was downloaded in 181 patients with Marquis DR ICDs. Patients were initially randomized to either MVP or DDD/R for 1 month, then crossed over to the opposite mode for 1 month. ICD diagnostics were analyzed for cumulative percentage atrial pacing (Cum%AP), Cum%VP, and duration of DDD/R pacing for spontaneous AVB. Results: Baseline characteristics included age 66 ± 12 years, EF 36 ± 14%, and NYHA Class II,III 36%. Baseline PR interval was 190 ± 53 msec and programmed AV intervals (DDD/R) were 216 ± 50 (paced)/189 ± 53 (sensed) msec. Mean Cum%VP was significantly lower in MVP versus DDD/R (4.1 ± 16.3 vs 73.8 ± 32.5, P < 0.0001). The median absolute and relative reductions in Cum%VP during MVP were 85.0 and 99.9, respectively. Mean Cum%AP was not different between MVP versus DDD/R (48.7 ± 38.5 vs 47.3 ± 38.4, P = 0.83). During MVP overall time spent in AAI/R was 89.6% (intrinsic conduction), DDD/R 6.7% (intermittent AVB), and DDI/R 3.7% (AF). No adverse events were attributed to MVP. Conclusions: MVP safely achieves functional atrial pacing by limiting ventricular pacing to periods of intermittent AVB and AF in ICD patients, significantly reducing Cum%VP compared to DDD/R. MVP is a universal pacing mode that adapts to AVB and AF, providing both atrial pacing and ventricular pacing support when needed. [source] Inappropriate ICD Therapy: Does Device Configuration Make a DifferencePACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 8 2006DWARAKRAJ SOUNDARRAJ Introduction: Inappropriate implantable cardioverter defibrillator (ICD) therapy (IT) is a common complication in patients with ICD. IT is commonly triggered by supraventricular tachycardias (SVT). Dual chamber ICDs (D-ICDs) may distinguish SVT from ventricular tachycardia/ventricular fibrillation better than single chamber ICDs (S-ICDs) and may be associated with a smaller incidence of IT. Methods: We reviewed the charts of 386 patients who had an ICD implanted for an AHA class I indication. Intracardiac electrograms were used to classify shocks as either appropriate or inappropriate. Results: Of 295 patients with an S-ICD, 66 (22.3%) received IT, compared to 5 (5.4%) of 91 patients with a D-ICD. The likelihood of being event-free at 1, 2, 3, and 4 years was 96.1%, 96.1%, 96.1%, and 89% for patients with D-ICD and 80.7%, 72.7%, 69.6%, and 66.4%, respectively, for patients with S-ICD (P < 0.001). Multivariate analysis showed no significant association with age, sex, history of atrial fibrillation, history of hypertension, or ejection fraction. SVTs were the commonest cause of IT in our patients. Conclusion: Patients with D-ICD are less likely to receive IT as compared to patients with S-ICD. [source] Use of an Intracardiac Electrogram Eliminates the Need for a Surface ECG during Implantable Cardioverter-Defibrillator Follow-UpPACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 12 2007KEVIN A. MICHAEL M.B.Ch.B. Background:A surface electrocardiogram (SECG) for pacing threshold measurements during routine implantable cardioverter-defibrillator (ICD) follow-up can be cumbersome. This study evaluated the use of an intrathoracic far-field electrogram (EGM) derived between the Can and superior vena cava (SVC) electrode,the Leadless electrocardiogram (LLECG), in dual chamber ICDs in performing pacing threshold tests. Methods:The LLECG was evaluated prospectively during atrial and ventricular pacing threshold testing as a substudy of the Comparison of Empiric to Physician-Tailored Programming of Implantable Cardioverter-Defibrillators trial (EMPIRIC) in which dual chamber ICDs were implanted in 888 patients. Threshold tests were conducted at 1 volt by decrementing the pulse width. Follow-up at three months compared pacing thresholds measured using LLECG with those using Lead I of the surface ECG (SECG). The timesaving afforded by LLECG was assessed by a questionnaire. Results:The median threshold difference between LLECG and SECG measurements for both atrial (0.00 ms, P = 0.90) and ventricular (0.00 ms, P = 0.34) threshold tests were not significant. Ninety percent of atrial and ventricular threshold differences were bounded by ± 0.10 ms and ,0.10 to +0.04 ms, respectively. We found that 99% of atrial and ventricular thresholds tests at six and 12 months attempted using LLECG were successfully completed. The questionnaire indicated that 65% of healthcare professionals found LLECG to afford at least some timesaving during device follow-ups. Conclusion:Routine follow-up can be performed reliably and expeditiously in dual chamber Medtronic (Minneapolis, MN, USA) ICDs using LLECG alone, resulting in overall timesaving. [source] Remote, Wireless, Ambulatory Monitoring of Implantable Pacemakers, Cardioverter Defibrillators, and Cardiac Resynchronization Therapy Systems: Analysis of a Worldwide DatabasePACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 2007ARNAUD LAZARUS M.D. Study Objective: To describe the daily routine application of a new telemonitoring system in a large population of cardiac device recipients. Methods: Data transmitted daily and automatically by a remote, wireless Home MonitoringÔ system (HM) were analyzed. The average time gained in the detection of events using HM versus standard practice and the impact of HM on physician workload were examined. The mean interval between device interrogations was used to compare the rates of follow-up visits versus that recommended in guidelines. Results: 3,004,763 transmissions were made by 11,624 recipients of pacemakers (n = 4,631), defibrillators (ICD; n = 6,548), and combined ICD + cardiac resynchronization therapy (CRT-D) systems (n = 445) worldwide. The duration of monitoring/patient ranged from 1 to 49 months, representing 10,057 years. The vast majority (86%) of events were disease-related. The mean interval between last follow-up and occurrence of events notified by HM was 26 days, representing a putative temporal gain of 154 and 64 days in patients usually followed at 6- and 3-month intervals, respectively. The mean numbers of events per patient per month reported to the caregivers for the overall population was 0.6. On average, 47.6% of the patients were event-free. The mean interval between follow-up visits in patients with pacemakers, single-chamber ICDs, dual chamber ICDs, and CRT-D systems were 5.9 ± 2.1, 3.6 ± 3.3, 3.3 ± 3.5, and 1.9 ± 2.9 months, respectively. Conclusions: This broad clinical application of a new monitoring system strongly supports its capability to improve the care of cardiac device recipients, enhance their safety, and optimize the allocation of health resources. [source] | ||||||||||