Subject(s)
Endocarditis, Bacterial/etiology , Equipment Failure , Pacemaker, Artificial/adverse effects , Staphylococcal Infections/etiology , Tricuspid Valve Insufficiency/etiology , Cardiac Pacing, Artificial/adverse effects , Cardiac Pacing, Artificial/methods , Device Removal , Echocardiography, Doppler , Endocarditis, Bacterial/diagnostic imaging , Follow-Up Studies , Heart Valve Prosthesis , Heart Valve Prosthesis Implantation/methods , Humans , Male , Middle Aged , Reoperation/methods , Risk Assessment , Staphylococcal Infections/diagnostic imaging , Staphylococcal Infections/physiopathology , Staphylococcus epidermidis/isolation & purification , Tricuspid Valve Insufficiency/diagnostic imaging , Tricuspid Valve Insufficiency/surgeryABSTRACT
OBJECTIVE: Our study aimed to analyze the predictive value of intra-operative bypass graft flow measurements for long-term mortality. METHODS: A total of 1593 consecutive coronary artery bypass graft (CABG) patients routinely underwent intra-operative bypass graft flow measurements with the transit-time flow meter (TTFM: Cardiomed(®)). The results of the flow measurements and the demographics were analyzed retrospectively. RESULTS: The mean follow-up was 3.8 years (0.5-8.8 years) with no losses to follow-up. Overall mortality was 10.1%. The preoperative left ventricular ejection fraction (LVEF) (echocardiograph) was the highest independent predictor of long-term survival (hazard ratio 0.97, p = 0.004) in all groups. The univariate analysis for the CABG I group showed that besides LVEF, female gender (hazard ratio 3.6, p = 0.02) was also significant. For the CABG II group, additive EuroSCORE (European System for Cardiac Operative Risk) (ES) (hazard ratio 1.4, p = 0.0001) and age (hazard ratio 1.1, p = 0.001) were significant. In the CABG III group, ES (hazard ratio 1.2, p < 0.0001), age (hazard ratio 1.04, p = 0.001), IMA (hazard ratio 0.5, p < 0.0001) and concomitant aortic valve replacement (AVR) (hazard ratio 2.1, p = 0.03) were significant, in addition to the LVEF. CONCLUSION: With quality-controlled surgeons checked by intra-operative TTFM, accurate quantification of preoperative LVEF significantly predicts long-term outcome. Effective bypass graft flows failed to predict outcome in CABG patients, regardless of the degree of coronary artery disease (CAD) and concomitant AVR.
Subject(s)
Coronary Artery Bypass/methods , Coronary Disease/surgery , Preoperative Care/methods , Ventricular Function, Left/physiology , Age Factors , Aged , Aged, 80 and over , Coronary Circulation/physiology , Coronary Disease/physiopathology , Echocardiography, Doppler/methods , Epidemiologic Methods , Female , Humans , Intraoperative Care/methods , Male , Middle Aged , Prognosis , Sex Factors , Stroke Volume/physiology , Treatment OutcomeABSTRACT
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.
Subject(s)
Adaptation, Physiological/physiology , Cardiac Pacing, Artificial/methods , Heart Rate/physiology , Pacemaker, Artificial , Patient Satisfaction , Aged , Aged, 80 and over , Cross-Over Studies , Exercise Test , Female , Follow-Up Studies , Humans , Intelligence Tests , Male , Middle Aged , Prospective StudiesABSTRACT
BACKGROUND: Health-related quality of life (HRQL) is increasingly accepted as an outcome measure when considering the effectiveness of therapeutic interventions. Little is known about the HRQL of patients with different clinical circumstances before and after pacemaker implantation (PMI). The purpose of this study was to investigate the influence of clinical symptoms and ECG diagnoses as predictors of improved HRQL in patients referred for PMI. METHODS: Sixty eight patients with different indications for PMI completed the MacNew Heart Disease Health-related Quality of Life Questionnaire (MacNew) and the Short Form-36 Health Survey (SF-36) before and one, three and six months after PMI. Symptoms, ECG indications and pacing mode were collected using the European Pacemaker Patient Identification Card codes. RESULTS: Within the first month after PMI overall Mac-New but not SF-36 scores improved significantly and was maintained during the entire 6 month follow up period. Improvement in HRQL as measured with the MacNew was rather related to baseline symptoms and ECG diagnosis than to the pacing mode. CONCLUSION: The important finding of this study is that improved HRQL seen after PMI appears to be largely driven by baseline symptoms and the ECG diagnoses rather than the pacing mode of the device.
Subject(s)
Pacemaker, Artificial/psychology , Quality of Life/psychology , Aged , Aged, 80 and over , Electrocardiography , Female , Follow-Up Studies , Humans , Male , Middle Aged , Surveys and QuestionnairesABSTRACT
BACKGROUND: Frequent and unnecessary right ventricular apical pacing increases the risk of atrial fibrillation or congestive heart failure. We evaluated a new pacing algorithm, managed ventricular pacing (MVP) which automatically changes modes between AAI/R and DDD/R in patients receiving pacemakers for symptomatic bradycardia. METHODS: Patients were randomized to the MVP mode or DDD/R mode for 1 month and then crossed over to the alternate pacing modality for an additional month. On completion of the crossover phase, the pacing mode selected was individualized and patients were followed for an additional 4 months. RESULTS: Of the 129 patients who successfully completed the crossover study, the cumulative percent ventricular pacing was significantly reduced in the MVP mode (median 1.4%) compared to the DDD/R mode (median 89.6%, 94.0% relative reduction; 95% CI 89.3-98.8%, P < 0.001). Patients with sinus node disease (SND, n = 51) when compared to patients with AV block (AVB) (n = 68) experienced a greater reduction in ventricular pacing with the MVP mode compared to the DDD/R mode (median relative reduction 99.1%; 95% CI 97.5-99.9% vs median relative reduction 60.1%; 95% CI 16.7-93.9% P < 0.001). The reduced percent ventricular pacing during MVP was sustained over longer term follow-up. CONCLUSIONS: The majority of patients with a bradycardia indication for cardiac pacing do not require ventricular pacing most of the time. The MVP mode significantly reduces unnecessary right ventricular pacing. This mode benefits even patients with intermittent AVB and is sustained over longer term follow-up.
