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Biomedical subjects

D Braile

Publications and source records attributed to D Braile.

3 recordsLinked to original sources
PubMed1992

Autonomic nervous system controlled closed loop cardiac pacing.

A multicenter clinical study is presented, which focuses on the reestablishment of closed loop cardiac control in patients with chronotropic insufficiency. Using the information about sympathetic tone contained in the myocardial contractility, it is possible to reconnect the heart rate to the physiological control mechanisms. Intracardiac impedance is measured with the ventricular electrode and the ventricular inotropic parameter (VIP) is derived from that. The VIP serves directly as input to the control of heart rate by the pacemaker. Over 200 patients have received autonomic nervous system (ANS) controlled pacemakers. The patient-pacemaker system was investigated in different ways. This included standard exercise tests, long-term studies of every day activities over 24 hours, psychological, and pharmacological challenges. To prove the validity of the approach we specifically looked at (1) the appropriateness of changes in paced heart rate with sympathetic tone during exercise, (2) the correlation between heart rate and sinus rate, if detectable, and (3) the correlation between the echocardiographically determined preejection period (PEP) and the VIP controlled heart rate.

Autonomic Nervous System↗
PubMed1992

[Measuring intracardiac impedance for the determination of sympathetic nerve activity in frequency-adapted electrostimulation--Part 2: Clinical results].

The results of a multicenter clinical study involving patients receiving the first ANS controlled rate adaptive pacemaker are presented. In the patients with primary or secondary chronotropic insufficiency, it is possible to reestablish the closed loop control system that includes the baroreceptors, the medulla oblongata, the cardiac output and the mean arterial blood pressure. This system serves to keep the blood pressure constant in the face of changing demands on the circulation. Utilizing intracardiac impedance measurements, the myocardial contractility can be determined, which contains information about the current sympathetic tone, and thus represents an excellent physiological input for a rate adaptive mechanism. The results presented are taken from a study population of over 200 patients. The objective evaluation of this new approach was performed echocardiographically, by ergometry and 24-hour Holter monitoring.

Adult↗