Pacemaker registration electronic-card. A proposal for a computerised system of storing of the pacemaker registration card.

This paper describes an example of a computerised system dedicated to store an Emergency Health Card into a compact and portable memory support such as the CMOS RAM CARD. Details are given from the system used and of the program developed for this task. In particular, patient, pacemaker and lead data are stored by the prototype system. The acquisition layout is similar to that of the European pacemaker registration card but some other sections are added. The possibilities of an introduction of a card system like this on E.E.C. countries is discussed.

Implant effects on polyurethane and silicone cardiac pacing leads in humans: insulation measurements and SEM observations.

Recently, polyurethane cardiac pacing leads have been under discussion because of some failures, probably due to modification of surface insulating properties. In order to verify the reliability of polyurethane versus silicone rubber as coating material, the authors, starting from previous clinical research, have carried out a study of electrical insulation related to implant time. At the same time the outer and inner lead surfaces have been submitted to scanning electron microscope (SEM) analysis. The results show, for the polyurethane leads, a significant increase in the leakage or currents in explanted samples, and a significant degradation (cracking) of the outer surfaces.

[Prognostic evaluation with invasive technics in patients with hyperkinetic ventricular arrhythmias]. / Valutazione prognostica con metodiche invasive di pazienti con aritmie ipercinetiche ventricolari.

The prognostic value of induction of ventricular tachycardia (VT) by programmed electrical stimulation (PES) was analyzed in 123 patients: 64 (Group I) with spontaneous recurrent VT and 59 (Group II) without a history of serious arrhythmias. Thirty-three patients with spontaneous VT underwent coronary and left ventricular angiography to compare electrical instability with the presence of ventricular disfunction and/or the extent of coronary artery disease (CAD). PES reproducibly induced VT in 49/64 patients with spontaneous VT (sensitivity = 77%) and in 6/59 patients without VT (specificity = 90%). Twenty-two patients (66%) had ventricular disfunction defined by an ejection fraction of less than or equal to 40% or regional wall motion abnormalities. Only 4 patients (33%) had proximal 3-vessel CAD. The mean follow-up period was 16 +/- 12 months. Eight of Group I patients died suddenly and 24 had recurrent symptomatic VT. Three of Group I patients died (1 cardiac failure, 2 non-cardiac deaths), all the survivors were free of serious arrhythmias. In Group I patients mortality was correlated with: recent anterior myocardial infarction, inducible sustained VT with PES, ejection fraction less than or equal to 0.40, ventricular ipoasynergy and or at least one coronary stenosis greater than or equal to 70%. This study suggests that inducible VT is a marker of the risk of sudden death. Electrical instability may occur independent from the etiology of cardiopathy, ventricular disfunction and extent of CAD, but these parameters are correlated to global and sudden mortality in the group of patients with spontaneous VT.

[Disorders of formation and conduction of the cardiac impulse in hypertrophic and congestive primary myocardiopathy]. / Turbe della formazione e della conduzione dell'impulso nella miocardiopatia primitiva ipertrofica e congestizia.

Little information is available regarding cardiac automatism and conduction disturbances in patients affected by congestive (CCM) or hypertrophic (HCM) cardiomyopathies. For this reason 29 patients with HCM (10 cases) and CCM (19 cases) and disturbances of sinus node automaticity or AV conduction underwent an electrophysiologic study. Eight patients affected by HCM were also submitted to cardiac catheterization. Sinus node function was normal in each of the HCM patients, and impaired in 6 of the 19 CCM patients. The intra-atrial conduction was prolonged in only one CCM case. One HCM and 2 CCM patients showed an impaired intranodal AV conduction. Thirteen patients (44%) showed a prolonged HV interval (3 HCM and 10 CCM patients). No calcific deposits on the aortic valve were discovered by X ray stratigraphic examination in any of the patients. In 6 cases a progression of the conduction disturbances was observed. Ventricular pre-excitation was present in 4 patients (13%).

[Pacemakers: concerning check-ups (author's transl)]. / Pacemakers: a proposito di controlli.

The Authors have re-examined their case histories of 1503 patients who have had 2459 pacemakers implanted and who have undergone check-ups as outpatients. All the complications which have arisen from 1967 to the present have been taken into consideration. The total number of complications has been found in 355 patients with 14% of the total number of pacemakers and they have been subdivided into 3 groups: 1st group: complications arising during the stay in hospital (110); 2nd group: complications arising after discharge from hospital and discovered by the patient (239); 3rd group: complications found casually during outpatients' check-ups (6). Of the complications found after discharge, 97% belong to the second group and only 3% to the third group. 657 substituted pacemakers have also been taken into consideration with the purpose of finding out the parameters which showed up as the battery was running down. Out of 145 pacemakers substituted because of flat batteries, 130 (90%) have shown brusque variations in the frequency of stimulation, while only 15 (10%) have shown variations in other parameters (width, length of impulse, etc). The Authors therefore retain that a periodic outpatients' check-up of the pacemakers is of little use as regards the patients' safety and the complete utilization of the device, while they advise that the patient be educated so as to be able to carry out his own daily control of the pacemaker.