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1.
Pacing Clin Electrophysiol ; 32 Suppl 1: S219-22, 2009 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-19250100

RESUMO

INTRODUCTION: Sleep-related breathing disorders occur in 20-30% of Europeans and North Americans, including 10% of sleep apnea syndrome (SAS). A preliminary study suggested that atrial overdrive pacing with a fixed heart rate might alleviate SAS. However, it is not known whether dynamic atrial overdrive pacing alleviates SAS. METHODS: Patients with indications for a dual chamber pacemaker or implantable cardioverter-defibrillator (ICD) were screened for SAS using the Pittsburgh Sleep Quality Index (PSQI) questionnaire. If PSQI was >5, cardio-respiratory polygraphy was performed before and 4 and 7 months after device implantation. Patients were randomized to algorithm ON-OFF (group A) or OFF-ON (group B) and the apnea-hypopnea index (AHI) was measured. RESULTS: Out of 105 consecutive patients, 46 (44%) had a positive PSQI. This analysis included 12 patients (mean age = 61 +/- 10 years, body mass index 28.9 +/- 6.5 kg/m(2), left ventricular ejection fraction = 38.3 +/- 13.6%; 10 men). All patients suffered from obstructive or mixed SAS. There were no significant differences in PSQI or AHI between baseline and follow-up or between the two study groups. Therefore, the study was terminated ahead of schedule. CONCLUSIONS: The prevalence of obstructive or mixed SAS was high in pacemaker or ICD recipients and reduced left ventricular ejection fraction. In these patients, long-term dynamic atrial overdrive pacing using did not improve PSQI or SAS. Therefore, patients with relevant obstructive or mixed SAS should not be offered atrial pacing therapy.


Assuntos
Desfibriladores Implantáveis/estatística & dados numéricos , Marca-Passo Artificial/estatística & dados numéricos , Medição de Risco/métodos , Síndromes da Apneia do Sono/epidemiologia , Terapia Assistida por Computador/estatística & dados numéricos , Feminino , Humanos , Incidência , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Fatores de Risco
2.
J Telemed Telecare ; 12(2): 97-102, 2006.
Artigo em Inglês | MEDLINE | ID: mdl-16539758

RESUMO

We developed a rule-based data filter for the automatic interpretation of data transmitted from implantable cardioverter defibrillators (ICDs). The feasibility and user acceptability of the data filter were tested in a multicentre study. Fifteen European centres analysed 10 cases each. The cases represented ICD follow-up findings, e.g. new tachycardia, battery depletion or sensing defects. The mean follow-up period was 68 days (SD 35). A questionnaire was used to collect information regarding the functionality and general concept of automatic data interpretation. A score of five or above (range 1-9) was classified as acceptable. According to the questionnaires, there was a high degree of satisfaction with the general concept of automatic data interpretation (mean 6.7, SD 1.2) and with user guidance (mean 7.1, SD 0.8). Safety (mean 7.0, SD 1.4) and accuracy (mean 6.7, SD 1.4) of the evaluation of device-related and clinical problems were regarded as high. Support in daily routine was considered to be high (mean 7.3, SD 1.1) as the system was easy to understand (mean 7.5, SD 0.9). The results indicated a high user acceptance with easy system handling.


Assuntos
Coleta de Dados/instrumentação , Desfibriladores Implantáveis , Telemetria/instrumentação , Atitude do Pessoal de Saúde , Redes de Comunicação de Computadores/instrumentação , Coleta de Dados/normas , Estudos de Viabilidade , Humanos , Consulta Remota/instrumentação
3.
J Am Coll Cardiol ; 44(1): 68-71, 2004 Jul 07.
Artigo em Inglês | MEDLINE | ID: mdl-15234409

RESUMO

OBJECTIVES: We studied the effects of cardiac resynchronization therapy (CRT) on heart failure (HF) patients with central sleep apnea (CSA). BACKGROUND: Patients with advanced HF often suffer from CSA with Cheyne-Stokes respiration. Cardiac resynchronization therapy improves myocardial function and exercise capacity in HF patients with conduction disturbances. The relationship between CRT and CSA is currently unknown. METHODS: Twenty-four patients (7 females; 62 +/- 11 years) with HF, a reduced left ventricular ejection fraction (24 +/- 6%), and left bundle branch block (QRS duration 173 +/- 22 ms) received a CRT device. The number of apneas and hypopneas per hour (apnea-hypopnea index [AHI]) and minimal oxygen saturation (SaO2min) were quantified by cardiorespiratory polygraphy. Fourteen patients showed CSA (AHI >5/h), and 10 patients had an AHI <5/h without CSA. Subjective sleep quality was assessed by the Pittsburgh Sleep Quality Index (PSQI). Data were evaluated before and after 17 +/- 7 weeks of CRT. RESULTS: In patients with CSA, CRT led to a significant decrease in AHI (19.2 +/- 10.3 to 4.6 +/- 4.4, p < 0.001) and PSQI (10.4 +/- 1.6 to 3.9 +/- 2.4, p < 0.001) without Cheyne-Stokes respiration and to a significant increase in SaO2min (84 +/- 5% to 89 +/- 2%, p < 0.001). There was no significant change in AHI (1.7 +/- 0.7 to 1.5 +/- 1.6), PSQI (2.4 +/- 0.5 to 2.6 +/- 0.9), and SaO2min (90 +/- 2% to 91 +/- 1%) in patients without CSA. CONCLUSIONS: Cardiac resynchronization therapy leads to a reduction of CSA and to increased sleep quality in patients with HF and sleep-related breathing disorders. This may have prognostic implications in patients receiving CRT.


Assuntos
Estimulação Cardíaca Artificial , Respiração de Cheyne-Stokes/terapia , Insuficiência Cardíaca/terapia , Apneia do Sono Tipo Central/terapia , Idoso , Respiração de Cheyne-Stokes/fisiopatologia , Doença Crônica , Teste de Esforço , Tolerância ao Exercício/fisiologia , Feminino , Insuficiência Cardíaca/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Respiração com Pressão Positiva , Estudos Prospectivos , Apneia do Sono Tipo Central/fisiopatologia , Estatística como Assunto , Resultado do Tratamento
4.
J Am Coll Cardiol ; 41(5): 765-70, 2003 Mar 05.
Artigo em Inglês | MEDLINE | ID: mdl-12628720

RESUMO

OBJECTIVES: We studied the acute effects of cardiac resynchronization therapy (CRT) on functional mitral regurgitation in heart failure (HF) patients with left bundle branch block (LBBB). BACKGROUND: Both an decrease [corrected] in left ventricular (LV) closing force and mitral valve tethering have been implicated as mechanisms for functional mitral regurgitation (FMR) in dilated hearts. We hypothesized that an increase in LV closing force achieved by CRT could act to reduce FMR. METHODS: Twenty-four HF patients with LBBB and FMR were studied after implantation of a biventricular CRT system. Acute changes in FMR severity between intrinsic conduction (OFF) and CRT were quantified according to the proximal isovelocity surface area method by measuring the effective regurgitant orifice area (EROA). Results were compared with the changes in estimated maximal rate of left ventricular systolic pressure rise (LV+dP/dt(max)) and transmitral pressure gradients (TMP), both measured by Doppler echocardiography. RESULTS: Cardiac resynchronization therapy was associated with a significant reduction in FMR severity. Effective regurgitant orifice area decreased from 25 +/- 19 mm(2) (OFF) to 13 +/- 8 mm(2) (CRT). The change in EROA was directly related to the increase in LV+dP/dt(max) (r = -0.83, p < 0.0001). Compared with OFF, TMP increased more rapidly during CRT, and a higher maximal TMP was observed (OFF 73 +/- 24 mm Hg vs. CRT 85 +/- 26 mm Hg, p < 0.01). CONCLUSIONS: Functional mitral regurgitation is reduced by CRT in patients with HF and LBBB. This effect is directly related to the increased closing force (LV+dP/dt(max)). The results support the hypothesis that an increase in TMP, mediated by a rise in LV+dP/dt(max) due to more coordinated LV contraction, may facilitate effective mitral valve closure.


Assuntos
Bloqueio de Ramo/diagnóstico por imagem , Bloqueio de Ramo/terapia , Estimulação Cardíaca Artificial , Cardiomiopatia Dilatada/diagnóstico por imagem , Cardiomiopatia Dilatada/terapia , Insuficiência da Valva Mitral/diagnóstico por imagem , Insuficiência da Valva Mitral/terapia , Idoso , Bloqueio de Ramo/complicações , Cardiomiopatia Dilatada/complicações , Estudos de Coortes , Ecocardiografia , Ecocardiografia Doppler , Feminino , Seguimentos , Testes de Função Cardíaca , Humanos , Masculino , Pessoa de Meia-Idade , Insuficiência da Valva Mitral/complicações , Variações Dependentes do Observador , Probabilidade , Estudos Prospectivos , Medição de Risco , Sensibilidade e Especificidade , Estatísticas não Paramétricas , Volume Sistólico , Resultado do Tratamento
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