Impact of Closed-Loop Stimulation, overdrive pacing, DDDR pacing mode on atrial tachyarrhythmia burden in Brady-Tachy Syndrome A randomized study

Puglisi, Andrea; Altamura, Giuliano; Capestro, Filippo; Castaldi, Bruno; Critelli, G; Favale, Stefano; Pavía, L; Pettinati, G.

doi:10.1016/j.ehj.2003.08.011

Cited by 27 publications

(14 citation statements)

References 23 publications

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“…Recently, a new physiological rate‐responsive pacemaker has been developed, based on the indirect measure of ventricular contractility: the Closed Loop Stimulation (CLS). Studies performed on the adult population have verified both the efficacy of the pacemaker to modulate heart rate during different stress and the clinical advantages in the treatment of some pathologies, 18–23 but no data are available on the behavior of such pacing strategy in younger patients.…”

Section: Introductionmentioning

confidence: 99%

Beat‐to‐Beat Heart Rate Adaptation in Pediatric and Late Adolescent Patients with Closed Loop Rate‐Responsive Pacemakers

Drago

Silvetti

Santis

et al. 2005

Pacing Clinical Electrophis

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The aim of this study was to evaluate the efficacy of physiological rate-responsive pacemakers (Closed Loop Stimulation--CLS) to pace pediatric and late adolescent patients undergoing rest, mental, standing, and exercise testing. Dual-chamber pacemaker is increasingly indicated for young patients. A new physiological pacing mode based on the indirect measure of ventricular contractility (CLS), has shown interesting results in adults, while no data on pediatric patients are available. RR intervals and beat-to-beat systolic and diastolic pressures were monitored in 12 pediatric patients (6 males, mean age 17 years [12-22 years]) who had a transvenous implant of Inos2+-CLS dual-chamber pacemaker (Biotronik GmbH, Berlin, Germany) and endocardial leads. All the patients showed correct electrical parameters at the implant and during the follow-ups. Paced RR intervals decreased significantly (F = 7.28, P = 0.01) from 0.85 +/- 0.08 seconds (rest) to 0.73 +/- 0.10 seconds (mental) and to 0.75 +/- 0.010 seconds (standing); systolic/diastolic pressure was significantly higher (F = 12.2, P = 0.002/F = 13.6, P = 0.001) in mental (134.4 +/- 19.9/74.4 +/- 8.1 mmHg) with respect to rest (115.1 +/- 18.3/61.0 +/- 6.1 mmHg), and standing (118.7 +/- 23.9/67.3 +/- 0.1 mmHg). During exercise the paced RR interval showed significant decrease of about 35% from baseline to maximum load (F = 24.90, P = 0.001) and systolic pressure increased significantly (F = 4.91, P = 0.019) by about 34% from baseline to maximum load. The comparison between paced and spontaneous rates showed very similar values and trend. In addition, CLS mode does not seem to overrun the spontaneous heart activity, when present. This is a study to evaluate CLS pacing in pediatric and late adolescent patients. The study shows that CLS pacing responds to both physical and non-physical stressors, providing physiological pacing rates, as previously observed in adults.

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Section: Introductionmentioning

confidence: 99%

Beat‐to‐Beat Heart Rate Adaptation in Pediatric and Late Adolescent Patients with Closed Loop Rate‐Responsive Pacemakers

Drago

Silvetti

Santis

et al. 2005

Pacing Clinical Electrophis

View full text Add to dashboard Cite

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“…7) Puglisi A et al evaluated the suppressive effect of three kinds of pacemaker rate-responsive algorithms on PAf, including conventional response, overdrive pacing and CLS modes, and found that the CLS mode effectively suppressed PAf for 4 and 7 months after PMI. 6) They inferred that turbulent autonomic Figure 2 Memory data obtained from pacemaker Based on memory data obtained from pacemaker clinic, the rates of ventricular and atrial pacing and atrial sensing more rapid than 150 bpm as surrogate marker of atrial fibrillation are shown. The on-and-off prophylactic effect of CLS against PAf attacks was obvious during hospitalization after PMI.…”

Section: Discussionmentioning

confidence: 99%

“…Recently, this rate-adaptive mode was shown to be possibly effective in suppressing paroxysmal atrial tachycardia burden. 6) However, as far as we are aware, there are few case reports which showed that CLS mode had obvious benefit in preventing paroxysmal atrial fibrillation (PAf) in SSS patients, even with antiarrhythmic agents. We observed distinct immediate and longterm effectiveness of CLS mode along with drug administration in preventing frequently repetitive development of PAfs in an SSS case.…”

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confidence: 99%

Prompt and Long-term Prophylactic Effect of Closed Loop Stimulation against Paroxysmal Atrial Fibrillation in a Patient with Sick Sinus Syndrome

et al. 2009

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A 72-year-old woman with sick sinus syndrome (SSS), who had frequent paroxysmal atrial fibrillations (PAfs) and normal cardiac function, was admitted to our hospital due to syncope. PAfs frequently occurred during the first week after DDD pacemaker implantation (PMI), with closed loop stimulation (CLS) rate-adaptive mode off, but were completely suppressed during the second week, with CLS on, and had been well-controlled over three years thereafter. However, PAfs occasionally occurred under intense sympathetic activity during 6 months after PMI as well, and were effectively terminated by disopyramide which had anticholinergic effect. Thus, the development and maintenance of PAf were thought to be associated with destabilized cardiac autonomic activities, that is, sympathetic and parasympathetic dominance, respectively. Additionally, heart rate variability analyses after implementation of CLS revealed the restoration of sympathetic and parasympathetic components. Accordingly, CLS mode was considered to play a critical role in preventing PAf by reflecting autonomic activity in heart rhythm in this SSS patient. (J Arrhythmia 2009; 25: 158-164)

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“…Both of these were expected to prevent development of PAF. [3][4][5][6] A lower rate was then set at 55 bpm ( Figure 1). AV delay was set to the rate-dependent (Dynamic) AV delay again.…”

Section: Case Reportmentioning

confidence: 99%

“…[1][2][3][4][5][6][7] However, there are few detailed reports concerning the effective management of atrioventricular (AV) interval for suppression of PAF which develops after implantation of a DDD pacemaker (PM) with the current standard functions of rate-response and MVP.…”

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confidence: 99%

Effective Management of Atrioventricular Interval for Paroxysmal Atrial Fibrillation That Developed After DDDR Pacemaker Implantation in a Sick Sinus Syndrome Patient

et al. 2015

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SummaryA 68-year-old man with sick sinus syndrome (SSS) was referred to our department for pacemaker implantation. After implantation of a pacemaker with rate-responsive dual chamber (DDDR) mode and minimized ventricular pacing (MVP) functions, paroxysmal atrial fibrillation (PAF) repeatedly developed. Pacemaker memory showed that the intrinsic atrioventricular (AV) (atrial pacing-ventricular sensing [Ap-Vs]) interval was paradoxically prolonged during rate-responsive atrial single-chamber (AAIR) mode rapid pacing because of MVP. Accordingly, to eliminate the paradoxical prolongation of the AV interval during rapid atrial pacing, we changed MVP to medium AV hysteresis and conducted DDDR mode pacing with rate-dependent AV delay. PAF then sharply decreased without antiarrhythmic drugs. ( 1-7) However, there are few detailed reports concerning the effective management of atrioventricular (AV) interval for suppression of PAF which develops after implantation of a DDD pacemaker (PM) with the current standard functions of rate-response and MVP.We implanted a DDD PM in an SSS patient and subsequently implemented the functions of rate-response and MVP at the same time. PAF then repeatedly developed after discharge. To suppress the PAF, we changed MVP to medium AV hysteresis and activated rate-dependent (Dynamic ® ) AV delay, while preserving the rate-response function. Thereafter, the repeated PAF sharply decreased without antiarrhythmic drugs or any additional therapy. We describe here the detailed clinical course of PAF, including PM memory, and assess the mechanism in this patient. Case ReportA 68-year-old man had been previously diagnosed with hypertension, sleep apnea syndrome, cardiomegaly, and sinus bradycardia. At the end of June 2010, he experienced syncope for the first time, when long pauses occurred during Holter monitoring which was performed to examine sinus bradycardia. Holter recording showed the development of PAF and consecutive pauses of 5.5, 3.5, and 3.45 seconds on its termination. In early July, he was admitted to our hospital for PMI with the diagnosis of SSS. Examination findings on admission were as follows: sinus bradycardia was 41 beats per minute (bpm) and the PQ interval was 150 milliseconds (ms) on a 12-lead electrocardiogram (ECG); the cardiothoracic ratio was 57% on chest X-ray; left atrial dimension (LAD) was 57 mm, left ventricular diastolic dimension was 59 mm, left ventricular ejection faction was 75% on echocardiogram; and the serum B-type natriuretic peptide (BNP) level was 142.9 pg/mL.In the middle of July, a DDD-mode PM (Entovis DR-T, Biotronik, Berlin, Germany) with 180 ms of AV delay on 60 bpm of lower-rate pacing was implanted (Figure 1). Leads were placed in the right atrial appendage and ventricular apex. Rate-dependent (Dynamic) AV delay was started on the date of PMI, although the function was virtually invalid because of DDD-mode back-up pacing with 180 ms of AV delay ( Figure 1).From the

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Impact of Closed-Loop Stimulation, overdrive pacing, DDDR pacing mode on atrial tachyarrhythmia burden in Brady-Tachy Syndrome A randomized study

Cited by 27 publications

References 23 publications

Beat‐to‐Beat Heart Rate Adaptation in Pediatric and Late Adolescent Patients with Closed Loop Rate‐Responsive Pacemakers

Beat‐to‐Beat Heart Rate Adaptation in Pediatric and Late Adolescent Patients with Closed Loop Rate‐Responsive Pacemakers

Prompt and Long-term Prophylactic Effect of Closed Loop Stimulation against Paroxysmal Atrial Fibrillation in a Patient with Sick Sinus Syndrome

Effective Management of Atrioventricular Interval for Paroxysmal Atrial Fibrillation That Developed After DDDR Pacemaker Implantation in a Sick Sinus Syndrome Patient

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