Biomedical subjects

P Klementowicz

Publications and source records attributed to P Klementowicz.

5 recordsLinked to original sources

PubMed1989

Treadmill assessment of an activity-modulated pacemaker: the importance of individual programming.

Maximum benefit from a rate-modulated pacemaker requires individualized programming of rate response settings. We tested an externally strapped activity-sensing pacemaker (Activitrax-Medtronic 8400) in eight healthy volunteers, to assess the pacing responses of the different rate response and activity threshold settings. Five males and three females, aged 20 to 70 years (mean 40), performed a total of 67 treadmill exercise tests, using a specific protocol designed to assess the activity-sensing unit. The external unit was compared to implanted units in four patients, to validate its accuracy. A reproducible sinus response to the treadmill protocol was observed, against which pacing responses were compared. The activity threshold determines the degree of activity required to elicit a pacing rate response, whereas the rate response setting determines the rate attained. Rates of 140 bpm were rarely achieved, despite vigorous exercise. The sensor responds rapidly to activity, not to physiologic demand; to increase in speed, not grade. Four patients performed repeated limited treadmill tests to determine their optimum program setting, with symptomatic status and the healthy volunteer sinus response as guides. These results, and those from the external Activitrax unit, suggest that LOW 6 and MEDIUM 6-10 settings will prove optimum for most patients.

Adult↗

PubMed1987

Retained pacemaker leads.

Increasingly, functionless pacemaker leads are being abandoned in place because they cannot be safely removed. One hundred eighty-nine intact or partially removed pacemaker leads were abandoned in situ in 152 patients between Jan. 1, 1965, and Dec. 31, 1985. The leads, sometimes several leads in a single patient, were deemed uninfected at the time of abandonment in 137 patients and contaminated with Staphylococcus epidermidis in 15 patients. All of the contaminated leads have remained clinically uninfected during follow-up. One clean lead became infected early after implantation and the patient died after an open cardiac operation to remove that lead and an adjacent abandoned lead that was adherent to the subclavian vein. No other patient has had a late complication during follow-up to 256 months (mean 47.6). Properly managed abandonment of an uninfected lead can carry a very low complication rate.

Electrodes, Implanted↗

PubMed1986

Interatrial conduction during cardiac pacing.

DDD pacemakers sense and pace right-sided cardiac chambers. The relationship of atrial to ventricular systole on the left side of the heart is of importance for systemic hemodynamics. Effective atrioventricular synchrony is partially determined by interatrial conduction time (IACT). At the time of DDD pacemaker implantation, interatrial conduction was measured using an intraesophageal pill electrode in 25 patients who were on no cardiac medications. Mean interatrial conduction time for all patients prolonged from 95 +/- 18 ms during sinus rhythm to 122 +/- 30 ms during right atrial pacing (p less than 0.001). In 16 patients with P wave duration less than 110 ms interatrial conduction prolonged from 85 +/- 10 ms during sinus rhythm to 111 +/- 9 ms during right atrial pacing (p less than 0.01) compared to 114 +/- 20 ms prolonging to 111 +/- 19 ms (p less than 0.01) in 9 patients with P wave duration greater than 110 ms. In each patient, while atrioventricular conduction prolonged with incremental right atrial pacing, interatrial conduction times did not vary. Interatrial conduction prolongs from baseline during atrial pacing and remains constant at all paced rates from 60-160 beats per minute. In addition to longer interatrial conduction times during sinus rhythm, patients with electrocardiographic P wave prolongation have longer interatrial conduction times during right atrial pacing than do normals (p less than 0.001). Based on interatrial conduction times alone, the AV interval during DDD cardiac pacing should be approximately 25 ms longer during AV pacing as compared to atrial tracking.

Aged↗

PubMed1986

The dynamic nature of ventriculoatrial conduction.

An endless loop tachycardia starts when the atrial sensory amplifier of a dual chamber pacemaker identifies an early atrial signal originating from a ventricular or atrial premature depolarization or from myopotential noise. The tachycardia will continue as long as ventriculoatrial conduction is sustained. By selecting the appropriate atrial sensitivity setting, postventricular atrial refractory period, or upper rate limit, it is possible to eliminate sustained endless loop tachycardia. Electrophysiological data obtained at the time of dual chamber pacemaker implantation can assist the physician when selecting these settings. This report summarizes our intraoperative data on ventriculoatrial conduction obtained from 432 consecutive patients. One hundred sixty-two patients had evidence of ventriculoatrial conduction including 14% of patients with antegrade complete heart block and 32% with 2:1 AVB. The majority of patients with preserved antegrade conduction had sustained retrograde conduction. During incremental ventricular pacing, ventriculoatrial conduction prolonged in the majority of patients, and with faster ventricular pacing rates, ventriculoatrial block developed. Ventriculoatrial block developed in half of the patients at a ventricular pacing rate exceeding 120 bpm. Analysis of these data suggests that by selecting an upper rate limit of 140 bpm, a postventricular atrial refractory period of 300 msec, and an atrioventricular interval of 125 msec, approximately 90% of patients will not have sustained endless loop tachycardia.

Aged↗

PubMed1985

Maintenance of exercise stroke volume during ventricular versus atrial synchronous pacing: role of contractility.

Although atrial synchronous and rate-responsive ventricular pacing have been compared, the importance of maintaining synchronized atrial systole in addition to rate responsiveness has been incompletely defined. That is, the effects of these two pacing modes on cardiac volumes and contractility have not been studied. Accordingly, 16 patients with normal ventricular function were studied while in the upright position and at rest with gated radionuclide ventriculography during both atrial synchronous and ventricular pacing. Twelve of these patients were also studied during low-level upright exercise (300 kilopond-meters). Rest and exercise ventricular pacing heart rates were matched to those recorded with synchronous pacing. Ventricular volumes were determined with a counts-based method. The ejection fraction and peak systolic pressure/end-systolic volumes or contractility between the two pacing modes. However, during exercise to identical heart rates, blood pressures, and workloads, although stroke volume was the same during exercise with atrial synchronous and ventricular pacing (78 +/- 13 vs 75 +/- 12 ml), end-diastolic and end-systolic volumes were lower with ventricular pacing than with atrial synchronous pacing (end-diastolic volume 101 +/- 13 vs 113 +/- 16 ml, p less than .001; end-systolic volume 26 +/- 4 vs 35 +/- 7 ml, p less than .001). Stroke volume during ventricular paced exercise was maintained at atrial synchronous pacing levels by means of increased contractility (ejection fraction of 74 +/- 4% during ventricular pacing vs 69 +/- 5% during atrial synchronous pacing, p = .002; peak systolic pressure/end-systolic volume ratio of 6.51 +/- 1 during ventricular pacing vs 4.85 +/- 1 during atrial synchronous pacing, p less than .001).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗