Biomedical subjects

Enrico Maria Greco

Publications and source records attributed to Enrico Maria Greco.

4 recordsLinked to original sources

PubMed2006

Atrial fibrillation and pacing algorithms.

Pacing prevention algorithms have been introduced in order to maximize the benefits of atrial pacing in atrial fibrillation prevention. It has been demonstrated that algorithms actually keep overdrive atrial pacing, reduce atrial premature contractions, and prevent short-long atrial cycle phenomenon, with good patient tolerance. However, clinical studies showed inconsistent benefits on clinical endpoints such as atrial fibrillation burden. Factors which may be responsible for neutral results include an already high atrial pacing percentage in conventional DDDR, non-optimal atrial pacing site and deleterious effects of high percentages of apical ventricular pacing. Atrial antitachycardia pacing (ATP) therapies are effective in treating spontaneous atrial tachyarrhythmias, mainly when delivered early after arrhythmia onset and/or on slower tachycardias. Effective ATP therapies may reduce atrial fibrillation burden, but conflicting evidence does exist as regards this issue, probably because current clinical studies may be underpowered to detect such an efficacy. Wide application of atrial ATP may reduce the need for hospitalizations and electrical cardioversions and favorably impact on quality of life. Consistent monitoring of atrial and ventricular rhythm as well as that of ATP effectiveness may be extremely useful for optimizing device programming and pharmacological therapy.

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PubMed2006

Pacemaker prevention therapy in drug-refractory paroxysmal atrial fibrillation: reliability of diagnostics and effectiveness of prevention pacing therapy in Vitatron selection device.

INTRODUCTION: Atrial fibrillation (AF), the most common and rising disorder of cardiac rhythm, is quite difficult to control and/or to treat. Non pharmacological therapies for AF may involve the use of dedicated pacing algorithms to detect and prevent atrial arrhythmia that could be a trigger for AF onset. Selection 900E/AF2.0 Vitatron DDDRP pacemaker (1) keeps an atrial arrhythmia diary thus providing detailed onset reports of arrhythmias of interest, (2) provides us data about the number of premature atrial contractions (PACs) and (3) plots heart rate in the 5 minutes preceding the detection of an atrial arrhythmia. Moreover, this device applies four dedicated pacing therapies to reduce the incidence of atrial arrhythmia and AF events. AIM OF THE STUDY: To analyze the reliability to record atrial arrhythmias and evaluate effectiveness of its AF preventive pacing therapies. MATERIAL AND METHODS: We enrolled 15 patients (9 males and 6 females, mean age of 71+/-5 years, NYHA class I-II), with a DDDRP pacemaker implanted for a "bradycardia-tachycardia" syndrome, with advanced atrioventricular conduction disturbances. We compared the number and duration of AF episodes' stored in the device with a contemporaneous 24h Holter monitoring. After that, we switched on the atrial arrhythmias detecting algorithms, starting from an atrial rate over 180 beats per minute for at least 6 ventricular cycles, and ending with at least 10 ventricular cycles in sinus rhythm. Thereafter, in order to evaluate the possible reduction in PACs number and in number and duration of AF episodes, we tailored all the four pacing preventive algorithms. Patients were followed for 24+/-8 months (from 20 to 32 months). RESULTS: All 59 atrial arrhythmia episodes occurred in the first part of this trial, were correctly recorded by both systems, with a correlation coefficient (r) of 0.96. During the follow-up, we observed a significant reduction not only in PACs number (from 83+/-12/day to 2.3+/-0.8/day) but also in AF episodes (from 46+/-7/day to 0.12+/-0.03/day) and AF burden (from 93%+/-6% to 0.3%+/-0.06%). An increase in atrial pacing percentages (from 3%+/-0.5% to 97%+/-3%) was also contemporaneously observed. CONCLUSION: In this pacemaker, detection of atrial arrhythmia episodes is highly reliable, thus making available an appropriate monitoring of heart rhythm, mainly suitable in AF asymptomatic patients. Moreover, the significant reduction of atrial arrhythmia episodes indicates that this might represent a suitable therapeutic option for an effective preventive therapy of AF in paced brady-tachy patients.

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PubMed2004

Sensors for rate responsive pacing.

Advances in pacemaker technology in the 1980s have generated a wide variety of complex multiprogrammable pacemakers and pacing modes. The aim of the present review is to address the different rate responsive pacing modalities presently available in respect to physiological situations and pathological conditions. Rate adaptive pacing has been shown to improve exercise capacity in patients with chronotropic incompetence. A number of activity and metabolic sensors have been proposed and used for rate control. However, all sensors used to optimize pacing rate metabolic demands show typical limitations. To overcome these weaknesses the use of two sensors has been proposed. Indeed an unspecific but fast reacting sensor is combined with a more specific but slower metabolic one. Clinical studies have demonstrated that this methodology is suitable to reproduce normal sinus behavior during different types and loads of exercise. Sensor combinations require adequate sensor blending and cross checking possibly controlled by automatic algorithms for sensors optimization and simplicity of programming. Assessment and possibly deactivation of some automatic functions should be also possible to maximize benefits from the dual sensor system in particular conditions. This is of special relevance in patient whose myocardial contractility is limited such as in subjects with implantable defibrillators and biventricular pacemakers. The concept of closed loop pacing, implementing a negative feedback relating pacing rate and the control signal, will provide new opportunities to optimize dual-sensors system and deserves further investigation. The integration of rate adaptive pacing into defibrillators is the natural consequence of technical evolution.

Journal Article↗

PubMed2003

Clinical evaluation of peak endocardial acceleration as a sensor for rate responsive pacing.

An innovative control parameter for rate responsive (RR) pacing that uses a sensor to measure mechanical vibrations generated by the myocardium during the isovolumetric contraction phase (peak endocardial acceleration [PEA]), has been devised by SORIN Biomedica (BEST Living System). To assess the physiological sensitivity of the pacemaker sensor along with reliability of the algorithm to supply appropriate pacing rates three different relationships were examined (linear regression analysis): (1) recorded deltaPEA exercise steps against the calculated energy cost of exercise (MET), (2) exercise pacing rates against predicted values, and (3) deltaPEA against exercise pacing rates. Fifteen patients (mean age 68 +/- 12 years) in NYHA Class I-II, implanted with the BEST Living System (Living 1 DDDR pacemaker) for advanced AVB and/or SSS, underwent one of the following maximal exercise stress protocols: bicycle (25 W, 2-minute steps) or Bruce or Chronotropic Assessment Exercise Protocol (CAEP). Pacing rates for each step were matched against those predicted by a reliable and tested custom software called Pacing Rate Profile Software (PRPS). The PRPS is based on the oxygen pulse reserve (OPR) method (OPR = VO2 reserve divided by heart rate reserve), American College of Sports Medicine (ACSM) formulas for calculating workload/metabolic requirements, and data derived from the Weber functional classes. On the basis of certain patient, data the PRPS then supplies appropriate metabolic pacing rate profiles. In all 15 patients linear regression analysis of deltaPEA against MET, as evaluated during the exercise protocol steps, showed a high correlation (r = 0.97). Likewise, a high correlation was also obtained between PRPS predicted heart rates and exercise pacing rates (r = 0.96) and PEA against exercise pacing rates (r = 0.96). The results of this study show that, through PEA dynamic monitoring, the SORIN Best Living System produces physiological pacing rates that are significantly related to metabolic needs.

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