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- Padeletti, Luigi, et al.
(författare)
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Duration of P-wave is associated with atrial fibrillation hospitalizations in patients with atrial fibrillation and paced for bradycardia
- 2007
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Ingår i: PACE. - : Wiley. - 1540-8159. ; 30:8, s. 961-969
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Tidskriftsartikel (refereegranskat)abstract
- Background: A trial fibrillation (AF) is a common problem in pacemaker patients. We conducted a prospective observational study in patients paced for bradycardia with associated paroxysmal or persistent AF, to determine whether P-wave duration may stratify patients at higher risk for AF recurrences and AF-related hospitalizations. The patients were evaluated for the prevalence, cause, and predictors of hospitalization. Methods: We studied 660 consecutive patients (50% male, 72 +/- 9 years) who received a dual-chamber pacemaker. Median value of baseline P-wave duration was equal to 100 ms (25%-75% quartile range equal to 80-120 ms). We used this cut-off to divide the patients into group A (P <= 100 ms), composed of 385 (58.3%) patients, and group B (P > 100 ms), composed of 275 (41.7%) patients. Results: In a median follow-up of 19 months, 173 patients were hospitalized for all causes, 130 for cardiovascular causes, and 85 for AF-related hospitalizations. Multivariate logistic analysis showed that P-wave duration > 100 ms identified patients at higher risk (OR = 1.6, 95% confidence interval (1.1-2.8), P = 0.044) for AF-related hospitalizations. Patients in group B (P > 100 ms) more frequently suffered AF-related hospitalizations (16.4% vs 10.4%, P = 0.02) and underwent more frequent cardioversions (14.5% vs 9.1%, P = 0.029) compared with group A (P < 100 ms). Conclusions: P-wave duration may define the risk of persistent AFrequiring cardioversion or AF-related hospitalization in patients with a pacemaker for bradycardia with associated paroxysmal or persistent AF.
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| 2. |
- Boriani, Giuseppe, et al.
(författare)
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Plateau waveform shape allows a much higher patient shock energy tolerance in AF patients.
- 2007
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Ingår i: Journal of cardiovascular electrophysiology. - : Wiley. - 1540-8167 .- 1045-3873. ; 18:7, s. 728-34
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- OBJECTIVES: To evaluate the possible pain reduction of the plateau waveform in atrial fibrillation (AF) patients. BACKGROUND: Previous studies have indicated that reduced amplitude waveforms would be less painful than a conventional (65/65% tilt) biphasic waveform. Computer modeling suggested that a moderately long (10-12 msec) plateau (flat topped) shock waveform would deliver equivalent effectiveness with the lowest possible peak amplitude. METHODS: We enrolled 27 patients at two sites with persistent AF with a total of 220 shocks delivered during internal atrial cardioversion using an interleaved crossover design. Patient response was scored in three ways: (1) a verbally reported discomfort score, (2) visual analog scale (VAS), and (3) a blinded observer reporting a contraction score. RESULTS: All scores were significantly reduced (P < 0.0001) by the plateau waveform with impressive statistics: Verbal discomfort (3.51 +/- 0.13 to 2.89 +/- 0.12), VAS (7.00 +/- 0.56 to 5.91 +/- 0.36), and contraction scores (1.94 +/- 0.12 to 1.62 +/- 0.12). The average pain threshold shift (TS) for the Verbal score was 2.34, while that for the VAS score was 2.30. (This means that the patient typically could tolerate 2.34 times as much energy with the plateau waveform for the same level of verbally reported discomfort.) The contraction TS was less at 1.57. Response scores were also corrected for the shock sequence number to control for the sensitization effect from multiple shocks. This increased the TS for the Verbal score to 3.58, but the shock number was not significant for the VAS. A pulmonary artery electrode return was associated with lower pain compared with a coronary sinus position. CONCLUSION: A plateau shaped biphasic waveform resulted in significantly increased shock energy pain tolerances. Controlling for session sensitization, patients tolerated over three times as much energy for the same verbally reported discomfort score.
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| 3. |
- Puererfellner, Helmut, et al.
(författare)
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Comparison of two strategies to reduce ventricular pacing in pacemaker patients
- 2008
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Ingår i: PACE. - : Wiley. - 1540-8159. ; 31:2, s. 167-176
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Tidskriftsartikel (refereegranskat)abstract
- Background: Managed Ventricular Pacing (MVP) and Search AV+ (SAV+) are two pacing algorithms designed to reduce ventricular pacing, MVP promotes conduction by operating in AAI/R mode with backup ventricular pacing during atrioventricular block (AVB). SAV+ operates in DDD/R mode with a nominal AV extension of 290 ms during atrial sensing and 320 ms during atrial pacing. The reduction in ventricular pacing was compared with these two algorithms in pacemaker patients. Methods: The EnRhythm and EnPulse clinical studies assessed the Percentage of ventricular pacing (% VP) after 1 month. Each patient's AVB status was assigned using the following hierarchical categories: persistent third-degree AVB (p3AVB), episodic third-degree AVB (e3AVB), second-degree AVB (2AVB), first-degree AVB (1AVB), and no AVB (nAVB). The% VP was tabulated for each AVB status category. Results: Data were available from 322 patients of whom 129 received DDD(R) pacing with the MVP algorithm activated and 193 patients with DDD(R) pacing and the SAV+ function activated, each for a month period. MVP resulted in a significantly lower median % VP than SAV+ in all AVB categories except for p3AVB: nAVB (0.3 vs 2.9, P < 0.0001), 1AVB (0.9% vs 80.6%. P < 0.0001), 2AVB (37.6 vs 99.3. P < 0.002), e3AVB (1.2 vs 42.2, P = 0.02), p3AVB (98.9 vs 100, P = 1.00). Conclusion: MVP resulted in a greater reduction in% VP than SAV+ across all patient groups except persistent third-degree AV block. The greatest reduction in%VP was observed in patients with mildly impaired AV conduction.
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