How different from pacemaker patients are recipients of implantable cardioverter-defibrillators with respect to psychosocial adaptation, affective disorders, and quality of life?

OBJECTIVE: To assess differences in psychosocial adaptation, quality of life, and incidence of affective disorders between patients with pacemakers and those with implantable cardioverter-defibrillators (ICDs). DESIGN: Patients aged 40-70 years who underwent a first pectoral implantation of a pacemaker or an ICD system were studied. All subjects were asked to complete the hospital anxiety and depression scale (HAD), the short form general health survey (SF-36), and a specially designed device related questionnaire. Data analysis was performed for three patient groups: pacemaker (n = 76), ICD patients who received therapeutic shocks (n = 45), and ICD patients who did not receive shocks (n = 31). RESULTS: There were no differences between the three patient groups in HAD scores or in any of the SF-36 subscales or summary ratings. Probable depressive disorder (depression score > 10) was observed in 5.2%, 6.5%, and 6.6%, and probable anxiety disorder (anxiety score > 10) in 13.1%, 9.7%, 13.3% of the pacemaker, non-shocked ICD, and shocked ICD patients, respectively. There were no sex differences. However, patients in the shocked ICD group were more likely than those in the other groups to report limitations in their leisure activities, to perceive their device as a "life extender," and to admit anxiety about battery depletion and technical problems. Forty per cent of shocked ICD patients would be interested in joining a support group. CONCLUSIONS: Despite having distinctly different medical histories and treatments, patients with pacemakers and ICDs responded similarly to validated tools of health status assessment. ICD patients who had received shocks perceived their device as prolonging their life and had greater anxiety about technical problems. Their endorsement of the potential benefits of a support group warrants further investigation.

Vibration, acceleration, gravitation, and movement: activity controlled rate adaptive pacing during treadmill exercise testing and daily life activities.

Activity-based sensors for rate adaptive pacing have been available for several years and now include several different types: vibration; acceleration; gravitation; and movement. However, a systematic comparison evaluating the relative advantages and disadvantages of these various sensors has received little study. The purpose of the present study was to compare these sensor subtypes using treadmill testing and an outdoor test circuit, which simulated daily life activities and included both uphill and downhill walking. Pacemakers were strapped on the chest of healthy volunteers and connected to one channel of an ambulatory recording device, which also recorded the subject's intrinsic heart rate. The pacemakers were programmed using an initial treadmill test to standardize the rate responsive parameters for each device. Nine different pacemaker models were studied including 3 vibration-based (Elite, Synchrony, Metros), 4 acceleration-based (Relay, Excel, Ergos, Trilogy), 1 gravitational-based (Swing), and 1 movement-based (Sensorithm) device. All devices demonstrated a prompt rate response with casual walking on flat ground. The vibration-, gravitational-, and movement-based pacemakers showed a pronounced rate decline during more strenuous work, e.g., walking uphill. This phenomenon was absent in the accelerometer-based units. In particular, the vibration- and movement-based units showed a higher rate with walking downhill compared to uphill. An optimally tuned rate behavior on the treadmill usually did not provide an optimal rate behavior during daily activities and there was a tendency to overstimulation during low workload. The development of the two newest sensors (gravitational and movement) did not result in an improved performance of rate response behavior. Overall, the accelerometer-based pacemakers simulated or paralleled sinus rate behavior the most closely.

[Therapy of ventricular tachyarrhythmia with disopyramid phosphate]. / Therapie ventrikulärer Tachyarrhythmien mit Disopyramid-Phosphat.

A controlled multicenter study has been carried out in 46 patients with ventricular tachyarrhythmias to define the antiarrhythmic effect of disopyramide phosphate. Monitoring of cardiac rhythm was performed during the whole study period by ambulatory Holter recording. The daily dose of disopyramide was 600 mg. It was found that disopyramide caused a reduction of at least 80% in the number of premature ventricular beats in 72% of the patients. Episodes of ventricular tachycardia were effectively suppressed in 65% of the patients. In 24 patients there was a reduction in the severity of the observed ventricular arrhythmias of at least one class in the classification of Lown. Analysis of the results showed a relationship between the antiarrhythmic effect and group mean plasma concentration of disopyramide.