RESUMEN
OBJECTIVES: Deep brain stimulation (DBS) is known to interfere with electrocardiographic (ECG) examinations. In emergency situations, such electrical interferences can not only thwart ECG diagnostics, but even induce an ECG pattern that causes the emergency medical service to initiate inadequate or even harmful therapy. Aim of this prospective study was to evaluate factors influencing ECG interpretation in DBS and to evaluate the susceptibility of ECG criteria 'frequency', 'rhythm', 'regularity', 'QRS-configuration', and 'ST-segment' on neurostimulation. PATIENTS AND METHODS: In 33 DBS patients (17 male, 16 female, mean age 64 years), limb-, 12 channel-, Nehb, and adhesive paddle-lead ECG were performed in activated (n = 33) and deactivated (n = 31) stimulation mode during outpatient follow-up examinations. The examinations were carried out using three different ECG devices (two portable emergency ECG-monitor/defibrillation/pacer-devices, one stationary hospital device), resulting in 4096 ECG leads. Statistics have been based on regression analyses and on a maximum likelihood estimation regression model. RESULTS: Monopolar settings were found to be a relevant factor interfering significantly more often with ECG recording than bipolar parameters (p < 0.0001). Due to recurring movement artefacts, deactivation of bipolar stimulation might even significantly worsen ECG quality (p < 0.0001). Interpretability of 'rhythm' (ß = -0.088, p = 0.03) and 'frequency' (ß = -0.110, p = 0.02) revealed significant negative correlation to the applied neurostimulation voltage. Nehb lead yielded in highest ECG interpretability. CONCLUSION: Bipolar neurostimulation mode barely affected the ECGs; furthermore, the suppression of motion artefacts by neurostimulation can improve ECG quality. If monopolar neurostimulation is required, at least, stimulation voltage should be as low as possible to obtain good stimulation results.
Asunto(s)
Artefactos , Estimulación Encefálica Profunda/instrumentación , Electrocardiografía , Neuroestimuladores Implantables , Enfermedad de Parkinson/terapia , Anciano , Estudios de Cohortes , Distonía/terapia , Femenino , Humanos , Masculino , Persona de Mediana Edad , Temblor/terapiaRESUMEN
AIMS: We compared pacing rate adaptation based on closed loop stimulation (CLS) or accelerometer sensor (AS) during acute mental and physical stress in the same patient. METHODS AND RESULTS: One month after Protos (Biotronik, Germany) pacemaker implantation, 131 chronotropically incompetent patients were randomized to AS or CLS for 3 months with crossover. Arithmetic and 6 min walk tests were performed in the non-rate-adaptive mode and AS and CLS rate-adaptive modes, respectively. At the end, patients had to select the individually preferred pacemaker sensor. Heart rate during mental stress was higher (3.0 +/- 9.2 bpm) in the CLS than in the AS mode (P = 0.004). Benefit in the walking distance compared with non-rate-adaptive pacing was similar for the two modes: added 27 +/- 96 m (AS, P = 0.013) and 30 +/- 116 m (CLS, P = 0.025). At the end of the walk, heart rate was higher by 4.8 +/- 21.4 bpm in AS than in CLS (P = 0.049). Twice as many patients preferred CLS over AS (P < 0.01). CONCLUSION: The arithmetic test was associated with a significantly higher heart rate for CLS than for AS, showing a greater sensitivity of CLS-based rate adaptation to mental stress. Performance during physical stress was comparable. Patients preferred CLS.