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  • 1
    Electronic Resource
    Electronic Resource
    Comparison of Induced and Spontaneous Atrial Tachyarrhythmias in Patients with a History of Spontaneous Atrial Tachyarrhythmias (2005)
    350 Main Street , Malden , MA 02148-5018 , USA , and 9600 Garsington Road , Oxford OX4 2DQ , UK . : Blackwell Science Inc
    Journal of cardiovascular electrophysiology 16 (2005), S. 0 
    Details
    ISSN: 1540-8167
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Introduction: This retrospective study investigated whether induced episodes could be used to predict the morphology of future spontaneous atrial episodes. Methods: Eighty-two patients (64 ± 12 years; 77% male; CAD in 60%; left ventricular ejection fraction 45 ± 16%) with a history of atrial tachycardia or atrial fibrillation (AT/AF) were implanted with a dual-chamber implantable cardioverter defibrillator (ICD) and followed for 6 months. A total of 224 episodes of induced and spontaneous AT/AF were classified into type I, II, and III according to the method of Israel et al. and then compared based on average cycle length (CL) and atrial amplitude. Episodes were also grouped as “pace-terminable” or “nonpace-terminable” based on the CL definition of Gillis et al. Results: The analysis of 121 induced episodes (from 80 patients) and 103 spontaneous episodes (from 43 patients) showed that within each arrhythmia type, there were no significant differences in CL or mean amplitude between induced and spontaneous episodes. Additional analysis of patients that had both induced and spontaneous episodes (n = 41) showed 78% had at least one spontaneous episode that matched the induced episode. Fifty-seven percent of spontaneous episodes were considered to be pace-terminable based on CL. Conclusions: Our data suggest that there is no significant difference between induced and spontaneous episodes of AT/AF of the same type. The majority of patients had at least one spontaneous episode of the same type as the induced episode, showing that induced atrial arrhythmias may be useful in predicting the morphology of future spontaneous episodes and in identifying patients potentially benefiting from atrial antitachycardia pacing.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1540-8167.2005.40726.x
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  • 2
    Electronic Resource
    Electronic Resource
    Atrial Signal Analysis and Defibrillation Threshold Assessment in Chronic Persistent and Reinduced Atrial Fibrillation (2002)
    Oxford, UK : Blackwell Science Inc
    Journal of cardiovascular electrophysiology 13 (2002), S. 0 
    Details
    ISSN: 1540-8167
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: De. brillation Threshold in Chronic and Reinduced AF. Introduction: Induced versus spontaneous atrial fibrillation (AF) is of interest for assessing atrial defibrillation threshold reproducibility. Methods and Results: Twenty-one patients with chronic AF underwent internal cardioversion with assessment of atrial defibrillation threshold at baseline and at reinduced AF. High right atrial (HRA) and coronary sinus (CS) bipolar recordings were analyzed to measure the mean local atrial period, its coefficient of variation, the 5th (P5) and 95th (P95) percentiles of atrial intervals, and the percentage of points lying at the baseline (number of occurrences), and to quantify AF organization. Atrial defibrillation threshold was comparable in baseline and reinduced AF in terms of leading-edge voltage and delivered energy. Baseline and reinduced AF were comparable with regard to overall signal parameters (both in HRA and CS) and the presence of an organized arrhythmia pattern. As for individual variables, P5 increased while P95 and coefficient of variation decreased in reinduced AF compared with spontaneous AF (statistical significance was achieved for all these parameters in HRA, but only for coefficient of variation and P95 in CS). Conclusion: Sustained AF reinduced after cardioversion of chronic AF is comparable with baseline AF in terms of atrial defibrillation threshold, atrial cycle length, and pattern of organization. Therefore, a clinical model based on reinduction of sustained AF after cardioversion is suitable for studying the effects of a series of interventions on atrial defibrillation threshold. However, because this model does not yield a form of AF with comparable indices of local refractoriness (e.g., P5), it is not recommended when analyzing local electrophysiologic properties.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1046/j.1540-8167.2002.00449.x
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  • 3
    Electronic Resource
    Electronic Resource
    Atrial Fibrillation in Patients with a Dual Defibrillator: Characteristics of Spontaneous and Induced Episodes and Effect of Ventricular Tachyarrhythmia Induction (2005)
    350 Main Street , Malden , MA 02148-5018 , USA , and 9600 Garsington Road , Oxford OX4 2DQ , UK . : Blackwell Science Inc
    Journal of cardiovascular electrophysiology 16 (2005), S. 0 
    Details
    ISSN: 1540-8167
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Background: The pattern of FF intervals during atrial fibrillation (AF) has been analyzed in induced and spontaneous AF episodes, after the induction of ventricular fibrillation (VF) and after atrial shock, in order to suggest practical considerations for AF management in patients implanted with antitachycardia devices. Methods: In 13 patients implanted with a dual-chamber defibrillator, FF intervals were analyzed during two separate induced AF episodes, before and after VF induction over AF, as well as during spontaneous AF episodes and after unsuccessful atrial shocks. The following parameters were considered: mean atrial cycle length (CL), atrial CL stability, and standard deviation of the atrial cycle. Results: The AF pattern had comparable characteristics considering two separate inductions of AF, as well as spontaneous AF episodes. Ventricular tachyarrhythmia induction resulted in a shortening of atrial CL (P 〈 0.02) and in a less organized AF pattern (P 〈 0.005). Changes in the FF interval after ineffective shock therapy showed a shortening of AF cycles after shocks with energies far below the defibrillation threshold. Conclusions: (a) The AF pattern is reproducible in separate inductions of sustained AF and in spontaneous episodes, (b) dynamic changes involving a shortening of the AF cycle and an evolution to a less homogeneous pattern occur after VF induction, revealing a complex interplay between AF and VF, and (c) FF interval analysis after ineffective shock delivery may allow the relationship between delivered shock energy and effective defibrillation energy to be estimated, thereby providing practical suggestions for step-up protocols in atrial cardioversion.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1540-8167.2005.50009.x
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  • 4
    Electronic Resource
    Electronic Resource
    Predictors of Atrial Antitachycardia Pacing Efficacy in Patients Affected by Brady-Tachy Form of Sick Sinus Syndrome and Implanted with a DDDRP Device (2005)
    350 Main Street , Malden , MA 02148-5018 , USA , and 9600 Garsington Road , Oxford OX4 2DQ , UK . : Blackwell Science Inc
    Journal of cardiovascular electrophysiology 16 (2005), S. 0 
    Details
    ISSN: 1540-8167
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Background: Recent options to treat atrial tachyarrhythmias (ATA) include implantable devices delivering antitachycardia pacing therapies (ATP). No prospective study selected patients with higher chances of episode termination by ATP or indicated the most effective ATP use. Our aim was to study ATP efficacy in patients with brady-tachy form of sinus node disease (SND), identifying clinical factors, ATA characteristics, and device features predicting ATP efficacy. Methods and Results: Three hundred and sixteen patients (105 M, aged 71.1 ± 8.8 years) received a DDDRP pacemaker and were prospectively followed. Median follow-up was 18 months: 37,125 ATA episodes occurred in 217 patients; ATP treated 5,536 of them. Overall, ATP efficacy was 50.0%. A multivariate analysis identified longer arrhythmia cycle lengths (OR = 1.25; CI = 1.07-1.47) and shorter delays to ATP delivery (OR = 0.15; CI = 0.10-0.22) as independent predictors of ATP efficacy for episodes preceded by ≥5 minutes of sinus rhythm. Additionally, ATP efficacy for all treated episodes was predicted by lower New York Heart Association (NYHA) class (OR = 0.64; CI = 0.42-0.98), episode classification as nonimmediate recurrence of ATA (non-IRAT) (OR = 0.07; CI = 0.02-0.33), absence of overlap in the device detection windows (OR = 0.54; CI = 0.32-0.91), and flecainide treatment (OR = 2.22; CI = 1.04-4.71). Conclusions: In patients paced for SND, multivariate analysis shows that ATP efficacy is associated to longer arrhythmia cycle lengths, shorter ATP delivery delays, NYHA class I, episode classification as non-IRAT, absence of overlap in the atrial arrhythmia device detection windows, and flecainide treatment.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1540-8167.2005.40716.x
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  • 5
    Electronic Resource
    Electronic Resource
    Atrial Fibrillation Precipitating Sustained Ventricular Tachycardia in Hypertrophic Cardiomyopathy (2002)
    Oxford, UK : Blackwell Science Inc
    Journal of cardiovascular electrophysiology 13 (2002), S. 0 
    Details
    ISSN: 1540-8167
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1046/j.1540-8167.2002.00954.x
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  • 6
    Electronic Resource
    Electronic Resource
    Atrial Tachyarrhythmia Recurrence Temporal Patterns in Bradycardia Patients Implanted with Antitachycardia Pacemakers (2004)
    350 Main Street , Malden , MA 02148-5018 , USA , and 9600 Garsington Road , Oxford OX4 2DQ , UK . : Blackwell Science Inc
    Journal of cardiovascular electrophysiology 15 (2004), S. 0 
    Details
    ISSN: 1540-8167
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Introduction: New-generation pacemakers allow continuous atrial tachyarrhythmia (AT) monitoring that provides accurate information about AT type, frequency, burden, and temporary evolution. Methods and Results: We performed a prospective multicenter study to describe AT temporal patterns in patients with sinus bradycardia and AT. Two hundred forty patients (123 men; age 71 ± 8 years) were implanted with a DDDRP pacemaker (model AT500, Medtronic Inc.). All patients were followed for 13 months. The first-month stabilization period of all patients was discarded from analysis. Seventy percent of patients had AT recurrences. Mean time to first AT recurrence (48.2 days, 95% confidence interval [CI] 37.0–59.5 days) was significantly longer than the time between first and second AT episode (10.3 days, 95% CI 6.7–13.9 days, P 〈 0.01). A minority of patients had a uniform time distribution of AT recurrences: 〈25% of patients had AT episodes in more than 6 of the 12 months considered in the study. The probability density function of consecutive sinus rhythm days between AT episodes was calculated for each of 40 patients who experienced 〉25 AT episodes and fitted by power law and exponential functions. The best fit was obtained by power law function in 60% of patients, by exponential function in 10%, and the two models gave comparable results in 30% of patients. Conclusion: In our population of patients with a history of sinus bradycardia and AT who were implanted with a new device equipped with atrial pacing therapies, 30% did not experience AT recurrences in the 12-month study period. Analysis of interevent time showed that in 60% of patients AT recurrences do not follow a uniform or random distribution. These findings bring into question the use of cross-over design and time to first AT recurrence as a clinical outcome in trials for AT therapy in this patient population. (J Cardiovasc Electrophysiol, Vol. 15, pp. 44-51, January 2004)
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1046/j.1540-8167.2004.03317.x
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  • 7
    Electronic Resource
    Electronic Resource
    Quantification of Fatty Tissue Mass by Magnetic Resonance Imaging in Arrhythmogenic Right Ventricular Dysplasia (2005)
    350 Main Street , Malden , MA 02148-5018 , USA , and 9600 Garsington Road , Oxford OX4 2DQ , UK . : Blackwell Science Inc
    Journal of cardiovascular electrophysiology 16 (2005), S. 0 
    Details
    ISSN: 1540-8167
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Introduction: Arrhythmogenic right ventricular dysplasia (ARVD) is a heart muscle disorder in which the pathological substrate is a fatty or fibro-fatty replacement of the right ventricular (RV) myocardium. Methods and Results: Magnetic resonance imaging (MRI) studies were performed in 10 patients with arrhythmogenic right ventricular dysplasia and in 24 matched controls in order to assess right ventricular epicardial/intramyocardial fatty tissue mass, RV myocardial mass, and RV functional parameters. Functional abnormalities were found in all ARVD cases. Patients with ARVD showed increased fatty tissue compared to controls (8.2 ± 4 g vs. 2.0 ± 1.0 g; P = 0.001), whereas no significant differences were found in RV myocardial mass (29.5 ± 9.2 g vs. 23.2 ± 6.7 g; P = NS). A correlation coefficient between 0.87 and 0.97 was found for repeated measurements. Conclusion: Quantification of fatty tissue with MRI is feasible and constitutes an objective method for differentiating normal from pathological conditions. This approach may lead to a complete diagnostic assessment of ARVD with the potential application for monitoring the evolution of the disease.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1046/j.1540-8167.2004.40498.x
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  • 8
    Electronic Resource
    Electronic Resource
    Combined Use of Morphology Discrimination, Sudden Onset, and Stability as Discriminating Algorithms in Single Chamber Cardioverter Defibrillators (2002)
    Oxford, UK : Blackwell Futura Publishing, Inc.
    Pacing and clinical electrophysiology 25 (2002), S. 0 
    Details
    ISSN: 1540-8159
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: BORIANI, G., et al.: Combined Use of Morphology Discrimination, Sudden Onset, and Stability as Discriminating Algorithms in Single Chamber Cardioverter Defibrillators. Morphology Discrimination (MD) is a rhythm discriminator based on QRS morphology analysis that can be combined with other discriminators like Stability, with or without Sinus Interval History (SIH) and Sudden Onset. Thirty-five patients implanted with a St. Jude Medical single chamber ICD were evaluated during exercise testing, during induced AF, and during follow-up for 14 ± 5 months. At exercise testing (60 episodes detected) MD had a specificity (SP) of 96.7% and Sudden Onset a SP of 91.7%; during induced AF (25 episodes) both MD and Stability had a SP of 96.0%. The diagnostic performance on spontaneous arrhythmias was as follows: for ventricular tachycardia (126 episodes) a sensitivity (SE) of 94.4% for MD, 92.1% for Sudden Onset, 89.7% for Stability without SIH and 79.4% for Stability + SIH; for sinus tachycardia (44 episodes) a SP of 86.4% for MD, 97.7% for Sudden Onset, 2.3% for Stability and of 95.5% for Stability + SIH. For AF (165 cases) a SP of 67.9% for MD, 69.1% for Stability and 90.3% for Stability + SIH, 44.8% for Sudden Onset. Use of MD alone provided a SE of 94.4% and a SP of 71.4% for spontaneous arrhythmias and combined use of the discriminators in a “2 of 3” diagnostic logic implied a SP of 90.9% with maintenance of 96.0% of SE. In single chamber ICDs a wide range of SE/SP ratios may be obtained by use of multiple discriminators, but use of the algorithm in a 2 of 3 diagnostic logic may achieve a SP of 90.9% and a SE of 96.0%.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1046/j.1460-9592.2002.01357.x
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  • 9
    Electronic Resource
    Electronic Resource
    Conversion of Recent-Onset Atrial Fibrillation to Sinus Rhythm: Effects of Different Drug Protocols (1998)
    Oxford, UK : Blackwell Publishing Ltd
    Pacing and clinical electrophysiology 21 (1998), S. 0 
    Details
    ISSN: 1540-8159
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: In a population of 417 hospitalized patients, the efficacy and safety of different drug regimens administered to convert atrial fibrillation (AF) of recent anset (≤ 7 days duration) to sinus rhythm were evaluated. All patients were in NYHA Class ≤ 2, and free of heart failure. They were randomly allocated to treatment with placebo in 121 patients; IV amiodarone, 5 mg/kg bolus, followed by 1.8 g/24 hours in 51 patients; IV propafenone, 2 mg/kg bolus, followed by 0.0078 mg/kg/min in 57 patients; p.o. propafenone, 600 mg p.o. in a single dose in 119 patients; and p.o. flecainide, 300 mg p.o. in a single dose in 69 patients. All patients were continuously monitored by Holter ECG, and the number of conversions to sinus rhythm was measured at 1, 3, and 8 hours. Results: (1) IV propafenone resulted in a higher conversion rate within 1 hour compared with the oral loading regimens of propafenone or flecainide, but the conversion rates at 3 and 8 hours were comparable, approximately 75% at 8 hours; 2) IV amiodarone was not different from placebo until 8 hours when it was associated with 57% of conversions; (3) conversion to sinus rhythm at 8 hours was observed in 37% of the placebo treated patients. Serious adverse effects occurred in few patients: two patients treated with flecainide and one treated with IV propafenone experienced left ventricular decompensation; one patient treated with placebo and two treated with flecainide had atrial flutter with rapid ventricular response. In conclusion, single-dose, oral loading with propafenone or flecainide are acceptable alternatives to conventional drug regimens in selected hospitalized patients. In addition, the measure of a placebo effect is mandatory in studies of recent-onset AF.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1540-8159.1998.tb01203.x
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  • 10
    Electronic Resource
    Electronic Resource
    Evaluation of the Atrial Evoked Response for Capture Detection with High-Polarization Leads (2005)
    350 Main Street , Malden , MA 02148-5018 , USA and 9600 Garsington Road , Oxford OX4 2DQ , UK . : Blackwell Science Inc
    Pacing and clinical electrophysiology 28 (2005), S. 0 
    Details
    ISSN: 1540-8159
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: AutoCapture™ based on the evoked response can be confounded by electrode polarization. In this study, polarization was measured in human subjects who had chronic atrial leads. The aim of the study was to determine whether electrode polarization can be measured using a time integral atrial evoked-response integral (AERI) of the negative portion of the atrial paced ER evoked-response signal and to determine whether high-polarization atrial leads unsuitable for AutoCapture™ can be identified a priori. Atrial intracardiac-electrogram (IEGM) signals from 39 patients with implanted pacemakers were recorded and analyzed. The signals were recorded during conventional atrial-threshold searches. A total of 221 atrial-capture thresholds were recorded, ranging from 0.25 to 2.75 V with a mean of 0.79 V. Each evoked response was evaluated using the AERI in a 36 ms window following the 0.4 ms atrial stimulus. The polarization was estimated as a linear function of stimulus voltage using the evoked-response signal integral of captured beats identified on the IEGM. The 221 threshold-search datasets were obtained using leads with eight different electrode materials. Polarization could be measured using AERI as a function of stimulus voltage. Furthermore, this polarization measure can be used to identify high-polarization leads, which are ill suited for the atrial AutoCapture™ algorithm.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1540-8159.2005.00059.x
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