RESUMEN
AIMS: The aim of the study was to evaluate the effects of patient gender onto primary pacemaker implantation, evaluating the database of the Institute of Quality Assurance Hessen in the federal state of Hessen, Germany. METHODS AND RESULTS: The database of the obligatory external quality control program for the years 2003-2006 was evaluated retrospectively. In 72 centres, 17 826 patients undergoing stationary primary pacemaker implantation have been registered. Male patients had more AV blocks when compared with women and less sick sinus syndrome and atrial fibrillation with bradycardia. In patients being 80 years and older, men received significantly more dual-chamber devices than women for the indications: AV block and sick sinus syndrome. In women, atrial pacing thresholds were significantly higher and P-wave amplitudes were significantly lower. Women had, independent from age or pacing system implanted, significantly more acute complications than men, with significant differences for pneumothorax and pocket haematoma. CONCLUSION: This large-scale real-life patient cohort of primary stationary pacemaker implantation showed that gender has an impact onto pacemaker implantation, with less favourable outcomes for women.
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Bloqueo Atrioventricular/terapia , Marcapaso Artificial/estadística & datos numéricos , Control de Calidad , Caracteres Sexuales , Síndrome del Seno Enfermo/terapia , Adolescente , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Niño , Preescolar , Estudios de Cohortes , Bases de Datos como Asunto , Femenino , Alemania , Adhesión a Directriz , Humanos , Lactante , Masculino , Persona de Mediana Edad , Marcapaso Artificial/clasificación , Estudios Retrospectivos , Resultado del Tratamiento , Adulto JovenRESUMEN
Since the establishment of cardiac resynchronization therapy in left bundle branch block and mechanical asynchrony, the adverse effects of right ventricular apical pacing have gained increasing scientific interest. The sequelae of "iatrogenic desynchronization" on cardiac structure and function as well as on patients' prognosis could be well documented. "Minimally desynchronizing" stimulation strategies could be an alternative for patients needing ventricular pacing. The search for hemodynamically more advantageous alternative right ventricular pacing sites has failed so far to deliver well validated results, and due to the somewhat higher lead dislodgment rates pure left ventricular pacing cannot be recommended, at least not in pacemaker-dependent patients. Hence there is the question for primary biventricular stimulation in patients with AV block. The results of several biventricular studies with limited numbers of patients have been promising with respect to structural and functional surrogate endpoints. Two major controlled prospective and prognostically orientated studies, the BIOPACE study and the BLOCK-HF study, are currently underway and will report results in the next few years. According to the actual guidelines of the European Society of Cardiology (ESC) the implantation of a biventricular system is recommended in patients with AV block even without left bundle branch block (Class IIa, evidence level C) if they fulfill the remaining criteria that justify the implantation of a biventricular system. According to the guidelines for pacemaker therapy of the German Cardiac Society (GCS) biventricular pacing can be considered in these patients. Both societies do expressly permit the implantation of biventricular systems with ICD backup if indicated.
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Estimulación Cardíaca Artificial/métodos , Bloqueo Cardíaco/terapia , Ventrículos Cardíacos/fisiopatología , Marcapaso Artificial , Bradicardia/diagnóstico por imagen , Bradicardia/fisiopatología , Bradicardia/terapia , Ecocardiografía , Electrodos Implantados , Bloqueo Cardíaco/diagnóstico por imagen , Bloqueo Cardíaco/fisiopatología , Insuficiencia Cardíaca/diagnóstico por imagen , Insuficiencia Cardíaca/fisiopatología , Insuficiencia Cardíaca/terapia , Ventrículos Cardíacos/diagnóstico por imagen , Humanos , Diseño de Prótesis , Ensayos Clínicos Controlados Aleatorios como AsuntoRESUMEN
Cardiomyopathies are an important and diverse group of heart muscle diseases in which the heart muscle itself is structural or functional abnormal. This often results in severe heart failure accompanied by arrhythmias and/or sudden death. Clinical and morphological diversity of cardiomyopathies can reflect the broad spectrum of distinct underlying molecular causes or genetic heterogeneity. In addition, modifying genes, life style and additional factors were reported to influence onset of disease, disease progression and prognosis. The individual patient's phenotype may reflect a summation and/or interaction of the underlying mutation with other genetic or environmental factors. During the last years major advances have been made in the understanding of the molecular and genetic basis of this type of disease. Nevertheless, much more progress in the identification of underlying mutations, susceptibility genes and modifier genes is important and indispensable for the development of new etiology orientated forms of therapy.
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Cardiomiopatías/clasificación , Cardiomiopatías/genética , Cardiomiopatías/patología , Análisis Mutacional de ADN , Predisposición Genética a la Enfermedad/genética , Insuficiencia Cardíaca/clasificación , Insuficiencia Cardíaca/genética , Insuficiencia Cardíaca/patología , Humanos , Miocardio/patología , Linaje , Fenotipo , Pronóstico , Factores de RiesgoAsunto(s)
Bloqueo de Rama/inducido químicamente , Digitoxina/toxicidad , Electrocardiografía/efectos de los fármacos , Taquicardia Ventricular/inducido químicamente , Anciano , Bloqueo de Rama/diagnóstico , Bloqueo de Rama/tratamiento farmacológico , Diagnóstico Diferencial , Digitoxina/administración & dosificación , Digitoxina/farmacocinética , Femenino , Sistema de Conducción Cardíaco/efectos de los fármacos , Humanos , Fragmentos Fab de Inmunoglobulinas/uso terapéutico , Pronóstico , Taquicardia Ventricular/diagnóstico , Taquicardia Ventricular/tratamiento farmacológicoRESUMEN
BACKGROUND: Over 50 % of cases of inflammatory cardiomyopathy are caused by bacterial or viral infection, the latter frequently Parvovirus B19, enterovirus (Coxsackie B virus) or adenovirus. Regarding the pathogenesis of the disease, its early phase is dominated by the infectious pathogen, which directly damages the myocardium, while in the second phase an important role is played by activation of the immune system and the antiviral immune response with immunological processes. HISTORY AND CLINICAL FINDINGS: A 24-year-old woman (height 175 cm, weight 88 kg) was admitted because of recurrent exertional dyspnea. She also reported increased feeling of weakness, fainting and vertigo for the preceding six months. She reported an influenza-like infection just before the onset of these symptoms. EXAMINATIONS: No abnormalities were found on physical examination. But echocardiography revealed markedly reduced ventricular contractility with an ejection fraction (EF) of 30 %. A cardiac catheterization was performed, as part of which a myocardial biopsy was obtained. DIAGNOSIS, TREATMENT AND COURSE: The biopsies showed an inflammatory cardiomyopathy and Parvovirus B19 was demonstrated. The patient received the accepted management of heart failure plus hyper-immunoglobins, 2 x 10 g i. v. on days 1 and 3. This treatment resulted in marked and lasting improvement of the clinical symptoms. After 36 months the clinical status was only slightly reduced, the EF being 40 % and the LV end-diastolic dimension 56 mm. CONCLUSION: Without an endomyocardial biopsy it would have been impossible to establish the diagnosis of inflammatory cardiomyopathy due to Parvovirus B19. It was only through the demonstration of the causative pathogen in myocardium that it was possible to provide aetiologically targeted treatment.
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Corazón/virología , Miocarditis/diagnóstico , Miocarditis/virología , Infecciones por Parvoviridae/diagnóstico , Parvovirus B19 Humano/aislamiento & purificación , Adulto , Biopsia , Cateterismo Cardíaco , Disnea , Ecocardiografía , Femenino , Humanos , Inmunohistoquímica , Miocarditis/tratamiento farmacológico , Miocardio/patología , Infecciones por Parvoviridae/tratamiento farmacológico , Infecciones por Parvoviridae/virología , Parvovirus B19 Humano/genética , Reacción en Cadena de la Polimerasa , Volumen Sistólico , Síncope , VértigoRESUMEN
Currently, it is assumed that the pharmacokinetic properties of the first minutes of an I.V. MR contrast media bolus are similar to those of an i.v. iodinated contrast media bolus used in CT. Correct timing of an MRA examination is crucial for obtaining sufficient arterial contrast. This study sought to evaluate the temporal change of arterial signal intensity within 150 s after i.v. bolus injection of Gd-DTPA. Thirty consecutive patients (14 women/16 men; mean age: 51 +/- 11 years) were prospectively examined with a 1.0 Tesla clinical scanner. A single axial slice was acquired in 1.25 sec with manufacturer provided gradient echo sequence through the aorta at the level of the renal arteries. Investigation was started simultaneously to the application of contrast media (0.1 mmol/kg bodyweight Gd-DTPA at three different rates 2 mL/sec, 3 mL/sec and 4 mL/sec) and repeated for 2.5 min. An additional echo Doppler examination excluded patients with any cardiac disorders. Maximum signal (1300% increase compared to the basic value) in the aorta was achieved 20 +/- 6 sec after start of bolus injection. Then a plateau phase was maintained for the remaining investigation time (2.5 min). No significant difference was shown for different injection rates. After a bolus injection of Gd-DTPA the arterial contrast remains on a high level for at least 2 min. However, correct timing of the bolus arrival is still crucial to discriminate arteries and veins. An injection rate between 2 mL/sec and 4 mL/sec has no influence on early contrast media dynamics.
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Medios de Contraste/farmacocinética , Gadolinio DTPA/farmacocinética , Imagen por Resonancia Magnética , Aorta , Ecocardiografía , Femenino , Humanos , Inyecciones Intravenosas , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Estadísticas no Paramétricas , Factores de TiempoRESUMEN
BACKGROUND: Atrial fibrillation is the most frequent arrhythmia. It can impair quality of life considerably. Due to thromboembolic complications it contributes to the patients' morbidity and mortality and to the costs for their medical treatment. PREVENTION: In chronic atrial fibrillation there is a need for adequate anticoagulation and heart rate control. In paroxysmal and intermittent atrial fibrillation it should be sought to prevent its progression to chronic atrial fibrillation. Since atrial fibrillation initiates negative processes of remodeling within the atrial myocardium, it has the tendency to perpetuate itself. From a theoretical point of view, it can be expected that all means which prevent episodes of atrial fibrillation or which terminate it immediately after its onset, are able to prevent or at least to delay the progression to chronic atrial fibrillation. Pharmacologic treatment is usually used to prevent recurrences of atrial fibrillation. Based on the actual data it can also be expected that pacemakers with special preventive pacing algorithms are able to reduce the atrial arrhythmic burden. Besides consequent overdrive pacing, more sophisticated algorithms like "suppression of premature atrial contractions", "post exercise response", "automatic rest rate" or "post mode-switch pacing" have been developed. They can be applied either alone or in combination with special lead positions (interatrial septal pacing or pacing of the triangle of Koch) or special stimulation configurations like dual site right atrial pacing or biatrial pacing. These pacing strategies cover the most relevant onset mechanisms of atrial fibrillation. Furthermore, there are algorithms to treat atrial tachyarrhythmias actively by antitachycardia pacing (ATP). First clinical results have shown that about 2/3 of the diagnosed atrial tachyarrhythmias could be terminated by these means immediately after their onset. ONGOING TRIALS: This article gives an overview over the principles of pacing in the management of atrial arrhythmias and ongoing clinical trials in this field. Before a definite judgement on the clinical relevance of these new preventive and therapeutic pacing strategies can be given, the results of these ongoing controlled clinical studies have to be analyzed.
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Fibrilación Atrial/prevención & control , Aleteo Atrial/prevención & control , Estimulación Cardíaca Artificial , Marcapaso Artificial , Taquicardia/prevención & control , Algoritmos , Animales , Bradicardia/terapia , Estimulación Cardíaca Artificial/métodos , Ensayos Clínicos como Asunto , Electrocardiografía , Humanos , Ensayos Clínicos Controlados Aleatorios como Asunto , Estudios Retrospectivos , Síndrome del Seno Enfermo/terapiaRESUMEN
BACKGROUND: In arterial hypertension, left ventricular hypertrophy (LVH) includes myocyte hypertrophy and fibrosis, which leads to LV diastolic dysfunction and, finally, heart failure. In spontaneously hypertensive rats, myocardial fibrosis was regressed and LV diastolic function was improved by treatment with the angiotensin-converting enzyme inhibitor lisinopril. Whether this holds true for patients with hypertensive heart disease was addressed in this prospective, randomized, double-blind trial. METHODS AND RESULTS: A total of 35 patients with primary hypertension, LVH, and LV diastolic dysfunction were treated with either lisinopril (n=18) or hydrochlorothiazide (HCTZ; n=17). At baseline and after 6 months, LV catheterization with endomyocardial biopsy, Doppler echocardiography with measurements of LV peak flow velocities during early filling and atrial contraction and isovolumic relaxation time, and 24-hour blood pressure monitoring were performed. Myocardial fibrosis was measured by LV collagen volume fraction and myocardial hydroxyproline concentration. With lisinopril, collagen volume fraction decreased from 6.9+/-0.6% to 6. 3+/-0.6% (P:<0.05 versus HCTZ) and myocardial hydroxyproline concentration from 9.9+/-0.3 to 8.3+/-0.4 microg/mg of LV dry weight (P:<0.00001 versus HCTZ); this was associated with an increase in the early filling and atrial contraction LV peak flow velocity ratio from 0.72+/-0.04 to 0.91+/-0.06 (P:<0.05 versus HCTZ) and a decrease in isovolumic relaxation time from 123+/-9 to 81+/-5 ms (P:<0.00002 versus HCTZ). Normalized blood pressure did not significantly change in either group. No LVH regression occurred in lisinopril-treated patients, whereas with HCTZ, myocyte diameter was reduced from 22. 1+/-0.6 to 20.7+/-0.7 microm (P:<0.01 versus lisinopril). CONCLUSIONS: In patients with hypertensive heart disease, angiotensin-converting enzyme inhibition with lisinopril can regress myocardial fibrosis, irrespective of LVH regression, and it is accompanied by improved LV diastolic function.
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Inhibidores de la Enzima Convertidora de Angiotensina/uso terapéutico , Antihipertensivos/uso terapéutico , Cardiomiopatías/tratamiento farmacológico , Hidroclorotiazida/uso terapéutico , Lisinopril/uso terapéutico , Miocardio/patología , Adolescente , Adulto , Anciano , Análisis de Varianza , Presión Sanguínea/efectos de los fármacos , Método Doble Ciego , Femenino , Fibrosis/tratamiento farmacológico , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Disfunción Ventricular Izquierda/tratamiento farmacológicoRESUMEN
Twenty-nine patients in whom severe bradyarrhythmias occurred exclusively during obstructive sleep apnea and in whom advanced sinus node disease or atrioventricular conduction system dysfunction had been excluded by invasive electrophysiologic evaluation were prospectively followed on nasal continuous positive airway pressure. During 54 +/- 10 months follow-up, no syncope and no sudden deaths were observed, suggesting that patients with sleep apnea-associated bradyarrhythmias and a normal electrophysiologic study appear to have a favorable prognosis with continuous positive airway pressure.
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Bradicardia/etiología , Respiración con Presión Positiva/efectos adversos , Síndromes de la Apnea del Sueño/terapia , Bradicardia/fisiopatología , Bradicardia/terapia , Estimulación Cardíaca Artificial , Electrocardiografía Ambulatoria , Femenino , Frecuencia Cardíaca/fisiología , Humanos , Masculino , Persona de Mediana Edad , Polisomnografía , Pronóstico , Estudios Prospectivos , Síndromes de la Apnea del Sueño/complicacionesRESUMEN
Presently, there are no well-defined standards for documentation of echocardiographic studies. Nevertheless, standards are essential to provide comparability of data and to realize electronic communication, both essential for quality management in echocardiography. Therefore, the working group "Standards and LV function" of the German Society of Cardiology developed a consensus for documentation of echocardiographic studies. In the present paper this consensus is presented and illustrated by typical clinical examples. Additionally, a prototype of a user-oriented software based on this data set is presented. The complete data set for transesophageal and transthoracic echocardiography and the software prototype can be downloaded at http:@echo.ma.uni-heidelberg.de.
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Ecocardiografía/normas , Estenosis de la Válvula Aórtica/diagnóstico por imagen , Documentación , Ecocardiografía Transesofágica/normas , Cardiopatías/diagnóstico por imagen , Enfermedades de las Válvulas Cardíacas/diagnóstico por imagen , Humanos , Insuficiencia de la Válvula Mitral/diagnóstico por imagen , Calidad de la Atención de Salud , Valores de Referencia , Programas Informáticos , Trombosis/diagnóstico por imagen , Función Ventricular IzquierdaRESUMEN
The AF Prevention by Overdriving (PROVE) trial is an ongoing prospective study of the effectiveness of atrial overdrive pacing combined with an Automatic Rest Rate function in the prevention of atrial arrhythmias. All patients who have received a Talent DR 213 pacemaker are eligible for enrollment into the study. After a 1-month monitoring period, the patients are divided into two groups. Group I includes patients with > or = 2 appropriate mode-switch (MS) episodes, or 1 MS episode of > or = 10 minutes, and/or > 300 atrial runs of > 5 beats/month. Group II includes all other patients. The number and duration of atrial arrhythmias are measured the pacemaker's Automatic Interpretation and Data Analysis software (AIDA). Patients' quality-of-life is measured by a validated functional status questionnaire. After having been grouped, the patients are randomly assigned, in a crossover design, to standard DDDR or overdrive pacing + Rest Rate, each programmed for a 3-month period. Preliminary results in 78 patients show a 34% reduction in the mean number of MS, and a mean 48% shortening of the overall duration of the episodes by overdrive pacing + Rest Rate, achieved by a mean 84% prevalence of atrial pacing. Overdrive pacing + Rest Rate was well tolerated and associated with a slight improvement in quality-of-life.
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Fibrilación Atrial/prevención & control , Función Atrial , Estimulación Cardíaca Artificial/métodos , Marcapaso Artificial , Anciano , Fibrilación Atrial/diagnóstico , Estudios Cruzados , Femenino , Estado de Salud , Frecuencia Cardíaca , Humanos , Almacenamiento y Recuperación de la Información , Masculino , Estudios Prospectivos , Calidad de Vida , Resultado del TratamientoAsunto(s)
Embolectomía , Embolia Pulmonar/tratamiento farmacológico , Embolia Pulmonar/cirugía , Terapia Trombolítica , Trombosis/tratamiento farmacológico , Trombosis/cirugía , Trombosis de la Vena/tratamiento farmacológico , Trombosis de la Vena/cirugía , Adulto , Articulación del Tobillo/irrigación sanguínea , Atrios Cardíacos/diagnóstico por imagen , Atrios Cardíacos/patología , Humanos , Pierna/irrigación sanguínea , Masculino , Embolia Pulmonar/diagnóstico por imagen , Trombosis/diagnóstico por imagen , Ultrasonografía , Trombosis de la Vena/diagnóstico por imagenRESUMEN
Time domain heart rate variability measurements and echocardiographic studies were performed in 35 patients with carcinoid syndrome. Carcinoid heart disease was present in 18 patients (51%). Heart rate variability parameters (standard deviation of all normal RR intervals, percentage of the number of pairs of adjacent normal RR intervals differing by >50 ms) were significantly reduced in patients with than in those without carcinoid heart disease.
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Cardiopatía Carcinoide/fisiopatología , Frecuencia Cardíaca , Adulto , Anciano , Cardiopatía Carcinoide/etiología , Electrocardiografía Ambulatoria , Femenino , Humanos , Masculino , Persona de Mediana EdadRESUMEN
From a registry of 136 patients undergoing pericardiocentesis, 14 patients with autoimmune and 15 patients with neoplastic effusions were selected. All underwent pericardioscopy, epicardial and pericardial biopsy with histologic, immunohistologic, and polymerase chain reaction/or in situ hybridization analysis for microbial DNAs and RNA. Pericardioscopy identified neoplastic effusions by the high occurrence of protrusions. Fibrin threads and layers and neovascularization were found in both groups. For identification of the inflammatory and neoplastic process, the combined analysis of the cytology of the effusion and epicardial biopsy evaluation proved to be most important. Epicardial biopsy demonstrated a slightly higher sensitivity for identifying neoplastic disorders in the pericardium than cytology alone. Pericardial biopsy was inconclusive. Intrapericardial administration of 1 g of crystalloid triamcinolone in autoreactive pericarditis prevented recurrence in 13 of the 14 cases after 3 months and in 12 of the 14 cases after 1 year. In neoplastic effusion, intrapericardial administration of 50 mg cis-platin for 24 h prevented recurrence of a hemodynamically relevant effusion after 3 months in all, and after 6-12 months in 14 of 15 patients. Mortality in neoplastic effusion due to noncardiac tumor progression was 47 and 80%, respectively, after 3 and 6 months, as can be expected in endstage neoplastic disease. This pilot study demonstrates that local drug application is feasible, life-saving, and well tolerated by the patients. It opens perspectives for local drug application in other cardiac disorders as well.
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Enfermedades Autoinmunes/complicaciones , Biopsia , Endoscopía , Neoplasias/complicaciones , Pericarditis/tratamiento farmacológico , Pericardio , Adolescente , Adulto , Anciano , Antiinflamatorios/administración & dosificación , Antineoplásicos/administración & dosificación , Infecciones Bacterianas/diagnóstico , Cisplatino/administración & dosificación , Femenino , Fibrina/análisis , Glucocorticoides/administración & dosificación , Humanos , Masculino , Persona de Mediana Edad , Neovascularización Patológica/patología , Paracentesis , Derrame Pericárdico/diagnóstico , Derrame Pericárdico/tratamiento farmacológico , Derrame Pericárdico/etiología , Derrame Pericárdico/microbiología , Pericarditis/diagnóstico , Pericarditis/etiología , Pericarditis/microbiología , Pericardio/microbiología , Pericardio/patología , Proyectos Piloto , Sensibilidad y Especificidad , Tasa de Supervivencia , Triamcinolona/administración & dosificaciónRESUMEN
To determine the incidence of complications of third-generation implantable cardioverter defibrillator (ICD) therapy, 144 patients were prospectively studied who underwent first implant of third-generation devices (i.e., ICD systems with biphasic shocks, ECG storage capability, and nonthoracotomy lead systems). During 21 +/- 15 months of follow-up, 41 (28%) patients had one or more complications. No patient died perioperatively (30 days) and no ICD infection was observed during follow-up. Complications included bleeding or pocket hematoma (hemoglobin drop > 2 g/dL) in 5 (3%) patients, prolonged reversible ischemic neurological deficit in 1 (1%) patient, postoperative deep venous thrombosis of leg in 1 (1%) patient, pneumothorax in 2 (1%) patients, difficulty to defibrillate ventricular fibrillation intraoperatively in 2 (1%) patients, generator malfunction in 1 (1%) patient, arthritis of the shoulder in 3 (2%) patients, and allergic reaction to prophylactic antibiotics in 2 (1%) patients. A total of seven lead related complications were observed in six (4%) patients including endocardial lead migration in four (3%) patients. Twenty-three (16%) patients received inappropriate shocks for supraventricular tachyarrhythmias (n = 13), non-sustained ventricular tachycardia (VT) (n = 7), or myopotential oversensing (n = 3). We conclude that serious complications such as perioperative death or ICD infection are rare in patients with third-generation ICDs. Lead-related problems and inappropriate shocks during follow-up are the most frequent complications of third-generation ICD therapy. Recognition of these complications should promote advances in ICD technology and management strategies to avoid their recurrence.
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Desfibriladores Implantables , Cardioversión Eléctrica/instrumentación , Implantación de Prótesis/efectos adversos , Taquicardia Ventricular/terapia , Ecocardiografía Transesofágica , Falla de Equipo , Femenino , Estudios de Seguimiento , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Estudios Prospectivos , Tasa de Supervivencia , Taquicardia Ventricular/diagnóstico por imagen , Resultado del TratamientoRESUMEN
Electromagnetic fields arising from a variety of different sources have been shown to interfere with normal pacemaker function. This study evaluated the possible interactions between two modern security systems and different pacemaker types. Fifty-three patients (27 single chamber pacemakers, 25 dual chamber pacemakers) have been tested routinely for their pacemaker function. Thirty-eight patients presented with unipolar sensing and 15 with bipolar sensing. The patients were asked to walk through an installed security system, an antitheft device, and electromagnetic access device with different field strengths while a six-channel ECG monitored the patients. The pacemaker systems were first measured in their basic programmed modes, then the intervention frequency was changed to 100/min and, thereafter, the maximum sensitivity without T wave oversensing was added. In the security system with the highest field strength (2,700 mA/m), a pacemaker malfunction could be observed in 13% of the monitored patients. In one case, a pacemaker (VVIR) switched to ventricular safety pacing (VOO mode). In the security system with the lower field strength (1,600 mA/m) we found a pacemaker malfunction in 4% of the tested patients. In the antitheft device (50 mA/m), in the electromagnetic access device (300 mA/m), and in pacemaker systems with bipolar sensing, none of these dysfunctions were observed. Phantom programming as described previously did not occur in any of the systems. Persons who are often in the vicinity of security systems should be equipped with a bipolar pacemaker system. Our findings indicate that patients with pacemakers should avoid contact with security systems.
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Análisis de Falla de Equipo , Marcapaso Artificial , Medidas de Seguridad , Adulto , Anciano , Anciano de 80 o más Años , Contraindicaciones , Electrocardiografía/instrumentación , Campos Electromagnéticos/efectos adversos , Diseño de Equipo , Femenino , Humanos , Masculino , Persona de Mediana Edad , Riesgo , Procesamiento de Señales Asistido por Computador/instrumentaciónRESUMEN
Device-based testing of single-lead pectoral defibrillators (defibrillation efficacy testing without an external defibrillation system after complete implantation of the device) resulted in an adequate defibrillation threshold (< or = 20 J) in 45 of 50 study patients (90%). Mean surgical implantation time (skin to skin) was 62 +/- 29 minutes without perioperative mortality and without implantable cardioverter defibrillator infection during follow-up. Thus, device-based testing appears to be a simple and safe method to test defibrillation efficacy of single-lead pectoral defibrillators.