Practice and Progress in Cardiac Pacing and Electrophysiology

385 Pages·1996·13.12 MB·English

by  Hugo Ector (auth.)

PRACTICE AND PROGRESS IN CARDIAC
PACING AND ELECTROPHYSIOLOGY
PRACTICE AND PROGRESS
IN CARDIAC PACING AND
ELECTROPHYSIOLOGY
edited by
M.ALIOTO
Department of Cardiology, Hacettepe University,
School of Medicine, Ankara, Turkey
KLUWER ACADEMIC PUBLISHERS
DORDRECHT / BOSTON / LONDON
Library of Congress Cataloging-in-Publication Data
Practice and progress in cardiac pacing and electrophysiology I edited
by Ali M. Oto.
p. cm. -- (Developments in cardiovascular medicine; v. 183)
Includes index.
ISBN-l 3: 978-94-010-6582-5 e-ISBN-l 3: 978-94-009-0219-0
001: 10.1007/978-94-009-0219-0
1. Cardiac pacing. 2. Arrhythmia--Treatment. 3. Implantable
cardioverter-deflbri llators. 4. Heart--Electric properties.
1. Oto, Ali. II. Series.
[ONLM: 1. Cardiac Pacing, Artificial. 2. Arrhythmia--therapy.
3. Pacemaker, Artificial. 4. Electrophysiology. WI DE997VME v.183
1996 / WG 168 P8954 1996]
RC684.P3P755 1996
617.4' 120645--dc20
ONLM/OLC
for Library of Congress 96-116
ISBN·13:978-94-0l0-6S82-S
Published by Kluwer Academic Publishers,
P.O. Box 17,3300 AA Dordrecht, The Netherlands.
Kluwer Academic Publishers incorporates the publishing programmes of
D. Reidel, Martinus Nijhoff, Dr W. Junk and MTP Press.
Sold and distributed in the U.S.A. and Canada
by Kluwer Academic Publishers,
101 Philip Drive, Norwell, MA 02061, U.S.A.
In all other countries, sold and distributed
by Kluwer Academic Publishers Group,
P.O. Box 322, 3300 AH Dordrecht, The Netherlands.
Printed on acid-free paper
All Rights Reserved
© 1996 Kluwer Academic Publishers
Softcover reprint of the hardcover 1st edition 1996
No part of the material protected by this copyright notice may be reproduced or utilized in any
form or by any means, electronic or mechanical, including photocopying, recording or by any
information storage and retrieval system, without written permission from the copyright owner.
To the memory of my father, Nuri Oto, M.D.
Contents
Foreword xiii
Preface xv
List of Contributors xvii
PART ONE: ARRHYTHMIAS AND ANTIARRHYTHMIC TREAT
MENT STRATEGIES
l. Endpoints and trials: a matter of life and death. Classification
of death in patients under antiarrhythmic treatment
Hugo Ector
2. The role of transient ischaemia in the pathophysiology of ven-
tricular arrhythmias in patients with coronary artery disease
Sergio L. Chierchia, Alberto Margonato & Alessandra Mailhac 7
3. Sudden death and tachyarrhythmias in athletes
Luc lordaens 13
4. The evaluation of antiarrhythmics
Philippe Coumel 23
5. Atrial fibrillation: maintaining the sinus rhythm
Samuel Levy 29
6. Arrhythmogenic right ventricular dysplasia
Paolo Rizzon, Maria Vittoria Pitzalis, Giovanni Luzzi, Francesco
Massari & Filippo Mastropasqua 37
vii
Vlll Contents
PART TWO: NON-INVASIVE ELECTROCARDIOLOGY
7. Signal averaged electrocardiogram. Current applications and
limitations
Thomas S. Faber & Marek Malik 47
8. Can analysis of heart rate variability predict arrhythmias and
antiarrhythmic effects?
Ronald W.E Campbell 63
9. QT dispersion
Ronald W.E Campbell 71
10. Use of baroreceptor reflex sensitivity in the prediction of risk after
myocardial infarction
Gaetano M. De Ferrari & Peter J. Schwartz 77
11. Ambulatory monitoring of T-wave alternans for detection of
cardiac electrical instability: scientific rationale and technical
considerations
Richard L. Verrier & Bruce D. Nearing 93
PART THREE: CARDIAC PACING
12. The state of electrical cardiac stimulation - 1995
Seymour Furman 103
13. Long-term rate adaptive atrial (AAIR) pacing: is it feasible?
Johan Brandt, Thomas Hthraeus & Hans Schuller 113
14. Single lead atrial synchronised ventricular (VDD) pacing
Jonathan C. Pitts Crick 119
15. Benefits of sensor driven dual chamber pacing
Massimo Santini, Antonio Auriti, Gerardo Ansalone, Barbara
Magris, Renato Ricci & Francesco De Seta 127
16. Cardiopulmonary evaluation of patients with rate responsive
pacemakers
P.E. Vardas & E.N. Simantirakis 137
17. Programming the upper rate behaviour and the atrial escape
interval in paced patients with unstable atrium
Veronique Mahaux, Andre Waleffe & Luc Mary Rabine 143
Contents IX
18. Automatic mode switching in DDDR pacemakers
Karel den Dulk 151
19. Pacing to prevent arrhythmias: bradycardia/tachycardia syndrome
Konrad K. Steinbach, M. Niirnberg & P. Rymaz 161
20. Managing paroxysmal atrial tachycardias in patients with pace-
makers
Richard Sutton 167
2l. Pacing to prevent atrial fibrillation
Alistair K.B. Slade & A. John Camm 175
22. The paradigm shift: pacing to prevent arrhythmias. Ventricular
tachycardia
Berndt Liideritz 189
23. How may dilated cardiomyopathy benefit from cardiac pacing?
Cecilia Linde 199
24. Various methods of monitoring the autonomic nervous system
using the pacing lead as a sensor. Clinical results and prospec-
tives
Max Schaldach 209
25. Rationale for the management of pacemaker and defibrillator
complications
Charles Byrd 239
PART FOUR: RADIOFREQUENCY ABLATION OF ARRHYTH
MIAS
26. Radiofrequency ablation of atrial flutter
Fernando Arribas, Maria Lopez Gil & Francisco G. Cosio 249
27. The spectrum of "Mahaim-like" accessory connections and their
associated ablation techniques
James H. McClelland, Warren M. Jackman, Karen J. Beckman,
Hiroshi Nakagawa, Mauricio Arruda, Xunzhang Wang, Michael
1. Prior & Ralph Lazzara 259
28. New approaches to ablation of left-sided and posteroseptal acces
sory pathways
Sanjeev Saksena, Irakli Giorgberidze, Ryszard B. Krol, Anand
Munsif, Nandini Madan & Philip Mathew 269
x Contents
29. Advances in transcatheter endocardial mapping and radiofre
quency ablation of ventricular arrhythmias
David G. Benditt, Stuart W. Adler, Graydon Beatty, Scott
Sakaguchi, Roger Hastings & Daniel Lafontaine 277
30. Catheter ablation of ventricular tachycardia in patients with
coronary heart disease
Martin Borggrefe, G. Hindricks, H. Kottkamp, A. Martinez-
Rubio, S. Yli-Mayry & Gunther Breithardt 289
PART FIVE: IMPLANTABLE CARDIOVERTER-DEFIBRILLATORS
31. Internal atrial defibrillation and implantable atrial defibrillators
Gregory M. Ayers 309
32. The cardiologist's dilemma: drugs or ICDs in patients with severe
ventricular dysfunction
Antonio Asso & Luis Placer 317
33. Can pump failure in ICD patients with low ejection fraction be
avoided by adding new pacing modes to current lCD's?
Patricia F.A. Bakker 329
34. Long-term outcome with transvenous (-subcutaneous) defibril
lation leads
Michael Block & Gunther Breithardt 337
35. Insights into ventricular tachycardia onset mechanism from
analysis of stored ICD electrograms
Alessandro Capucci, Giovanni Quinto Villani, Luciano Sallusti,
Daniela Aschieri & Alessandro Rosi on behalf of the ICD-VT
Italian Study Group 347
36. Managing the problem of atrial tachyarrhythmias in patients with
lCD's
J6rg Neuzner & Heinz Friedrich Pitschner 353
37. Technological advances in implantable cardioverter defibrillator
leads and waveforms: paving the way for smaller ICDs
Seah Nisam 361
38. Driving restrictions after cardioverter/defibrillator implantation
Berndt Luderitz & Werner Jung 371
Contents xi
39. Arrhythmias, implantable devices and driving "The United
Kingdom Advisory Panel Experience"
Michael C. Petch 381
Index 387
Foreword
One of the great international and regional, but truly world, meetings is
EUROPACE. Most recently i~ was held during June 1995 In-Istanbul, Turkey.
This biennial meeting has traditionally drawn the best and brightest of the
world of pacing, electrophysiology and tachycardia management and combined
presentation of original and competitively submitted material with teaching
of younger workers and symposia for the exchange of controversial attitudes
and positions about newly developing technologies. While the European
symposia (EUROPACE) began with cardiac pacing alone, they have now
progressed far beyond placing, accompanying the growth, vigor and variety
of the therapeutic interventions possible. The complexity of cardiac pacing and
associated therapies has caused EUROPACE to progressively increase in the
richness and diversity of its content. Comparison between earlier EUROPACE
and that of 1995 will reveal startling evolution and differences. The 1995
Scientific Sessions included presentations concerning the new technologies
in cardiac pacing, i.e., single lead VDD pacing, automatic mode switching
and the use of cardiac pacing to inhibit ventricular tachyarrhythmias and
atrial fibrillation and flutter and for hemodynamic benefit in dilated car
diomyopathy and hypertrophic obstructive cardiomyopathy.
Arrhythmias were analyzed for diagnosis and therapy and topics of general
and continuing interest included heart rate variability and sudden death in
presumably healthy, young athletes. Newer areas of electrocardiography such
as heart rate variability, signal averaging and QT dispersion, as diagnostic
techniques were also presented. Implantable cardioversion and defibrillation,
a progressively greater therapeutic area in the management of ventricular
and possibly supraventricular arrhythmias was presented as were the other
significant therapeutic interventions of growing importance.
In all, there are five sections in the published proceedings:
A. Arrhythmias and antiarrhythmic treatment strategies;
B. Non-invasive electrocardiology;
C. Cardiac pacing;
xiii