Table Of ContentCARDIAC PACING AND ELECTROPHYSIOLOGY
Cardiac Pacing and
Electrophysiology
A bridge to the 21st century
Edired by
A.E. AUBERT
Universiry Hospital Gasfllllisberg. Lel/vel/. Belgium
H. ECTOR
Universil)' Hospital GaSlllllisberg. Lel/ven, Be/gitl/11
and
R. STROOBANDT
51. jozel HospÎ/af. Oostende. Belgium
....
"
SPRINGER SCIENCE+BUSINESS MEDIA, B.V.
Libr~ry or Congress Calaloging-in-Publicalion Data
C~rdiac paclng and electrophyslologV a brldge to the 21st century I
edlted by A.E. Aubert, H. EClor, and R. StroobanOt.
p. CII.
lncludes Index.
ISBN 978-94-010-4377-9 ISBN 978-94-011-0872-0 (eBook )
DOI 10.1007/978-94-011-0872-0
1. Cardiac pacing. 1. Aubert. Andre E .. 1943- II. Ector.
Hugo. 1943- III. Stroobandt. R. IRohndl
(DM.M: 1. Cardiac Pac Ing, ArtlfIClal--trends.
2. Electrophyslology--trends. 3. ElectrophyS10loQY
-instrullentatlon. 4. "aceaaker. ArtlfIC1a)--trends.
5. Oeflbrlllators. I1plantable--trends. WG 168 C2633 1944)
RC684.P3C314 199"
617.1I·120645--dc20
ON...H/OLC
for Llbrary of Congress 93-38818
ISBN 978-94-010-4377-9
Prin/ed on acid·frec pap'"
Ati Rights Rcscrvcd
© lY94 Springer Science+Business Media Dordrechl
Origina!1y published by Kluwer Academic Publishcrs in lY94
Softeover reprim of Ihe hnrdcovcr 1S I editioll 1994
No part of Ihe material prolected by this copyright notiee may bc reproduced or
u!ilizcd in any form or by any mean,. electronic or mechanical.
induding pholocopying. recording ar by any information storage and
retricval system. without ..... riuen pcrmission from the copyright owner.
This book is dedicated to the memory of His Majesty King Baudouin, King
of the Belgians (1930-1993)
"His Majesty the King of the Belgians Patron of the 6th European Sympos
ium on Cardiac Pacing"
F. Kuypers «:" INBEL
Regentlaan 54 Bd du Regent 54
1000 Brussel 1000 Bruxelles
tel. 32-02-2171111
Contents
Foreword XlII
List of Contributors XVII
PART ONE: Electrophysiology
1. Equipment for the electrophysiology laboratory: possibilities
and limitations
Willem R.M. Dassen, Rob G.A. Mulleneers & loep R.L.M.
Smeets 3
2. Vasovagal syncope: clinical presentation, classification and
management
Richard Sutton 15
3. Classification of antiarrhythmic drugs in relation to mechanisms
of arrhythmias
Michiel 1. lanse 23
4. Electrophysiological characteristics in arrhythmogenic right
ventricular dysplasia and dilated cardiomyopathies
Guy Fontaine, R. Frank, R. Tsezana, 1. Tonet, E. Velasquez &
G. Lascault 31
5. Classification of death in patients under antiarrhythmic
treatment
Ralph Rogers, Hugo Ector, Ann Rubens, Carl Timmermans,
Hein Heidbiichel & Hilaire De Geest 41
6. Heart rate variability. Methodology and physiological basis
Lii Fei & Marek Malik 49
vii
Vlll Contents
7. Heart rate variability and QT interval: their relationships with
the cardiac frequency
Philippe Coumel & Pierre Maison-Blanche 63
8. Role of dynamic QT interval in Holter tapes to stratify risk in
postmyocardial infarction patients
E. Rodriguez Font, E. Horns, J. Guindo, V. Marti, X. Vifiolas,
A. Bayes Genis & A. Bayes de Luna 73
9. Heart rate variability in patients with angina pectoris
Nina Rehnqvist, lnge Bjorkander, Lennart Forslund, Claes
Held & Paul Hjemdahl 79
10. Time and frequency domain analysis of heart rate variability
after myocardial infarction
Federico Lombardi, Giulia Sandrone & Alberto Malliani 83
11. Signal averaged ECG. Technical principles, possibilities and
limitations
Alfons Sinnaeve & Hugo Tassignon 93
12. Optimizing the predictive value of the signal-averaged ECG for
serious arrhythmic events in the post-infarction period
Nabil EI-Sherif 117
13. Signal-averaged analysis of the P wave: possible applications in
different settings
M. Ali Oto 125
14. Late potentials during acute myocardial ischaemia
P.E. Vardas, F.J. Parthenakis & E.G. Manios 131
15. Radiofrequency catheter ablation in the treatment of
supraventricular tachycardias
Frank Simonis, Erik Andries & Pedro Brugada 137
16. Anatomical versus electrophysiological approaches for ablation
of the slow pathway in patients with AV nodal reentrant
tachycardia
Michel Haissaguerre, Bruno Fischer, Philippe Ie Metayer,
Pierre Jais, Philippe Egloff & Jean-Fran~ois Warin 145
Contents IX
PART TWO: Pacing
17. Cardiac pacing in Europe in 1992: a new survey
Giorgio A. Feruglio 157
18. The myocardium-electrode interface at the cellular level
Max Schaldach 169
19. The myocardium-electrode interface at the macro level
W. Irnich 189
20. Unipolar versus bipolar leads
Ivo Kersschot 203
2l. Single lead VDD pacing: an update
Giovanni Enrico Antonioli, Lucia Ansani, Roberto Audoglio,
Gabriele Guardigli, Gianfranco Percoco & Tiziano Toselli 209
22. Substantial improvement of screw-in electrodes
Petras Stirbys 221
23. Physiological cardiac pacing: an individual objective
J. Claude Daubert, Philippe Mabo, Daniel Gras, Christophe
Leclercq & Thierry Lelievre 227
24. Pacemaker syndrome during atrial-based pacing
S. Serge Barold 251
25. Dual chamber pacemaker therapy in cardiomyopathy
S. Serge Barold, Lukas Kappenberger, Claude Daubert & Guy
Fontaine 269
26. ODD rate-responsive pacing: state of the art
Massimo Santini, G. Ansalone & G. Cacciatore 281
27. Heart rate response based on changes in central venous oxygen
saturation, minute ventilation and body activity
Ole-Jorgen Ohm, Svein Frerestrand & Finn Hegbom 289
28. DDDR and atrial arrhythmia
Veronique Mahaux 303
29. Holter and pacemaker diagnostics
Paul A. Levine 309
x Contents
30. Clinical relevance of histograms in the follow-up of DOOR
pacemakers
Marc M.J. Berkhof. Jozef P. Snoeck, Marnix P.N. Goethals &
Marc J. Claeys 325
31. Holter and telemetry in pacemakers and ICDs: new
developments
Alain Ripart 333
32. Automatic measure of the interface capacitor and the total
cardiac impedance
Francisco Perez G6mez, Manuel Montero, Miguel A. Pastor,
Francisco Perez-Vizcaino, Maria J. Perez-Vizcaino & Pablo
Gonzalez 347
33. Critical analysis of the different algorithms designed to protect
the paced patient against atrial tachyarrhythmias in dual
chamber pacing
Philippe Ritter, S. Cazeau, Y. Kojoukharov, L. Henry, H.
Podeur, A. Lazarus & J. Mugica 355
34. Mode switching in DOOR pacing
Richard Sutton 363
PART THREE: Defibrillators
35. Indication for ICD implantation and selection of patients:
present and future
Luc Jordaens 373
36. The optimum tilt for defibrillation
W. Irnich 381
37. Cerebrovasomotor reactivity predicts tolerance to tiered therapy
with implantable cardioverter-defibrillators
Igor Singer & Harvey Edmonds, Jr. 387
38. Clinical utility of telemetered electrograms in pacemakers and
ICDs
Roland Stroobandt, Filiep Vandenbulcke, Roger Willems &
Alfons Sinnaeve 399
Contents Xl
39. High patient acceptance for implantable cardioverterl
defibrillator (lCD): quality of life and patient acceptance
Berndt Ltideritz, Werner lung & Matthias Manz 411
40. Cardiac pacing and electrophysiology: how much technology do
we need?
R.W.F. Campbell 419
41. Medical technology assessment and reimbursement policy of
implantable devices in Belgium: possibilities and limitations for
the future
Rob van den Oever 423
42. Socioeconomic aspects of implantable devices: can we afford
new technology?
Konrad K. Steinbach 431
Index 439
Foreword
In 1992, clinical cardiac electrophysiology became a recognized sub-speciality
of the American Board of Internal Medicine. The formal recognition of this
highly specialized and technical field of medicine represents the culmination
of thirty years of remarkable scientific and intellectual discovery. Beginning
in the 1950s, cardiologists realized that cardiac arrhythmias were the cause
of significant morbidity and the sudden death of at least 350,000 patients
every year in the United States alone. At that time the only tools available
for analyzing abnormal heart rhythms were the standard EKG machine and
careful deductive reasoning.
During the early 1960s, cardiac pacemakers reflected the first foray in the
electrical therapy of cardiac arrhythmias. Pacemakers were first implanted
in order to control syncopal episodes related to bradycardic heart rhythms.
Although crude and bulky devices, their utility was immediately obvious to
physicians and patients alike. The recognition that electrical signals could be
recorded from inside the heart and that the heart's rhythm could be controlled
by the application of electrical energy began the era of clinical cardiac
electrophysiology which was to follow.
In the late 1960s and early 1970s and at the peak of the Vietnam conflict.
a group of cardiologists with special training in cardiac electrophysiology
were sequestered at the US Public Health Service Hospital at Staten Island.
Their sole responsibility was to develop techniques which would enable the
clinical study of arrhythmias. Nearly simultaneously. at several cardiologic
centers in Europe, identical clinical investigations proceeding independently
were developing similar techniques with similar exciting results. Out of those
preliminary and ground-breaking investigations came procedures now
broadly known as Electrophysiologic Studies.
ELECTROPHYSIOLOGY
The current book as edited by Drs. A.E. Aubert, H. Ector and R. Stroobandt
reflects the nearly unbelievable advances made in the field of cardiac electro-
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