Table Of ContentHOW TO FACE 'THE FACES' OF CARDIAC PACING
How to face 'the faces'
of
CARDIAC PACING
edited by
ERIK ANDRIES
Department of Cardiology, D.L. V. Hospital, Aalst, Belgium
PEDRO BRUGADA
Department of Cardiology, D.L. V. Hospital, Aalst, Belgium
and
ROLANDSTROOBANDT
Department of Cardiology, St lozef Hospital, Dostende, Belgium
(; CYANAIWID
Springer-Science+Business Media, B.V.
First published 1992
Reprinted 1993
ISBN 978-94-010-5139-2 ISBN 978-94-011-2582-6 (eBook)
DOI 10.1007/978-94-011-2582-6
Printed on acid-free paper
AlI Rights Reserved
© 1992, 1993 Springer Science+Business Media Dordrecht
Originally published by Kluwer Academic Publishers in 1993.
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.
Contents
List of contributors ix
1. A synoptic view on syncope
Erik Andries, Hilde Willems, Sinan Gursoy, Paul Nellens, Marc
Goethals & Pedro Brugada 1
2. Pseudo brady arrhythmias
Pedro Brugada, Sinan Gursoy, Jacob Atie, Marc Goethals,
Gunter Steurer, Hilde Willems, Josep Brugada & Erik Andries 23
3. Cardiac pacing for bradyarrhythmias
LucdeRoy 29
4. From VVI to DDD pacemakers: glossary of terms and normal
functions
Alfons Sinnaeve 41
5. A practical guide to the interpretation of DDD pacing electro
cardiograms
Roland Stroobandt 83
6. Rate-adaptive cardiac pacing
A. John Camm & Clifford J. Garratt 119
7. Dual chamber rate responsive (DDDR) pacing: ventricular
versus atrial timing
Roland Stroobandt, Roger Willems & Alfons Sinnaeve 127
v
vi Contents
8. Facing the 'faces' of pacing after implantation
Marc Goethals, Willy Timmermans, Roger Willems, Erik Andries
& Roland Stroobandt 139
9. Antitachycardia pacing
Luc Jordaens, Patrick Vertongen, Etienne Van Wassenhove &
Denis L. Clement 183
10. Electrical treatment of tachycardias
Jean Fran~ois Leclercq, Isabelle Denjoy, Antoine Leenhardt &
Philippe Coumel 191
II. Review of implantable defibrillator therapy
Morton M. Mower & Seah Nisam 209
12. The implantable defibrillator
Andre Waleffe 215
13. Combined automatic implantable cardioverter-defibrillator and
permanent pacemaker systems
Roland Stroobandt, Roger Willems & Alfons Sinnaeve 221
14. Surgical treatment of cardiac arrhythmias. The physician's point
of view
Pedro Brugada, Francis Wellens, Paul Nellens, Sinan Giirsoy,
Jacob Atie, Gunter Steurer, Erik Andries & Hugo van Ermen 229
15. Cost-benefit analysis of arrhythmia technology
Hein Heidbiichel & Hugo Ector 241
16. Arrhythmia technology. The insurer's point of view
Rob van den Oever 255
Index 267
Preface
How to face 'the faces' of cardiac pacing represents an editor's compiled
selection of lectures on cardiac pacing and electrophysiology.
Electrical stimulation of the heart is an ever-changing and, at times,
explosive field. The number of implanting centres is growing tremendously
and pacing is not exclusively confined to arrhythmologists. Therefore, the
editors attempted to organize a course being both practical in daily clinical
management and instructive in understanding technical concepts.
The glossary of terms have to be clearly understood before one is able to
interpret the complex electrocardiograms of DDD and especially DDDR
pacemakers. Those electrocardiograms have to be approached in a system
atic way, using a step-by-step analysis.
The main clinical symptom requiring pacemaker implantation is syncope.
It cannot be over-emphasized that syncope is a clinical diagnosis merely
based on history and physical examination.
The organization of a pacemaker follow-up clinic depends on local
facilities and needs. The effectiveness of pacing controls markedly increases
when using a systematic approach. Repeated optimal adjustment of pro
grammable functions is part of the control.
Antiarrhythmic drugs are loosing popularity in the treatment of tachy
arrhythmias. Nonpharmacologic treatment (antitachypacing, implantable defi
brillators and antiarrhythmic surgery) at the present time have definite
indications, probably expanding in the future.
When complexity in electronic devices increases, repercussions on ex
penses, either by the government or social and private insurances, needs
consideration.
We are grateful to the contributors of this volume. By editing this text, we
have learned a great deal, and we hope you will enjoy facing the 'faces' of
pacing.
September 1991 Erik Andries,
Pedro Brugada,
Roland Stroobandt
VB
E. Andries, P. Brl/gada & R. Straabandt (eds.), Haw to face 'the faces' afcardiac pacing. vii.
© 1992 Kluwer Academic Publishers, Dordrecht
List of contributors
Erik ANDRIES
Department of Cardiology, O.-L.-Vrouwziekenhuis, Moorselbaan 164, B-9300 Aalst, Belgium
Co-authors: Hilde Willems, Sinan Giirsoy, Paul Nellens, Marc Goethals and Pedro Brugada
Pedro BRUGADA
Cardiology Centre, O.-L.-Vrouwzickenhuis, Moorselbaan 164, B-9300 Aalst, Belgium
Co-authors Chapter 2: Sinan Giirsoy, Jacob Atie, Marc Goethals, Giinter Steurer, Hilde
Willems, Josep Brugada and Erik Andries
Co-authors Chapter 14: Francis Wellens, Paul Nellens, Sinan Giirsoy, Jacob Atie, Giinter
Steurer, Erik Andries and Hugo van Ermen
A.JOHNCAMM
Department of Cardiological Sciences, St. George's Hospital, Medical School, Cranmer
Terrace, London SW17 ORE, u.K.
Co-author: Clifford J. Garratt
LucDE ROY
Department of Cardiovascular Pathology, University Clinic UeL de Mont-Godinne, Avenue
du Dr Therasse, 1, B-5530 Yvoir, Belgium
Marc GOETHALS
Cardiology Centre, O.-L.-Vrouwziekenhuis, Moorselbaan 164, B-9300 Aalst, Belgium
Co-authors: Willy Timmermans, Roger Willems, Erik Andries and Roland Stroobandt
Hein HEIDBDcHEL
Laboratory for Electrophysiology, University of Louvain, Gasthuisberg, Herestraat 49,
B-3000 Louvain, Belgium
Co-author: Hugo Ector
Luc JORDAENS
Department of Cardiology, University Hospital Ghent, De Pintelaan 185, B-9000 Ghent,
Belgium
Co-authors: Patrick Vertongen, Etienne Van Wassenhove and Denis L. Clement
ix
x List of contributors
Jean Fran90is LECLERCQ
Department of Cardiology, Lariboisiere University Hospital, 2, Rue Ambroise Pare, F-75010
Paris, France
Co-authors: Isabelle Denjoy, Antoine Leenhardt and Philippe Coumel
Morton M. MOWER
Cardiac Pacemakers Inc., 4100 Hamline Avenue North, St. Paul, MN 55112-5798, U.S.A.
Co-author: Seah Nisam
Alfons SINNAEVE
Technical University of Ostend, Zeedijk 101, B-8400 Oostende, Belgium
Roland STROOBANDT
Dept. of Cardiology, St. Jozef Hospital, Nieuwpoortsesteenweg 57, B-8400 Oostende, Belgium
Co-authors Chapters 7 and 13: Roger Willems and Alfons Sinnaeve
Rob Th. M. VAN DEN OEVER
Department Insurance Medicine, School of Public Health, University of Louvain, Kapucijnen
voer 35, B-3000 Louvain, Belgium
Andre W ALEFFE
Department of Cardiology, University Hospital, Sart-Tilman, B-400 1 Liege, Belgium
1. A synoptic view on syncope
ERIK ANDRIES, HILDE WILLEMS, SINAN GORSOY,
PAUL NELLENS, MARC GOETHALS & PEDRO BRUGADA
INTRODUCTION
Definition. Syncope is defined as a transient loss of consciousness with
spontaneous recovery. Syncope should not be confused with dizziness,
unsteadiness, coma or shock. Epileptiform seizures usually are absent.
However, they do occur when the attack is prolonged. Loss of consciousness
in the presence of focal neurologic signs should be defined as a transient
ischemic attack (TIA).
Incidence. Syncope is a common medical problem occurring in approxi
mately 20% of the population [1, 21. Although it can be assumed that most
people with a syncopal episode don't seek medical attention, nevertheless,
syncope accounts for 3% of the emergency room admissions and 1% of the
total hospital admissions in the USA. When recurrent, it may account for
more than 10% of the total population undergoing invasive electrophysio
logical investigations.
CAUSES OF SYNCOPE
Syncope has many causes, ranging from benign disorders (e.g. vasodepressor
or hyperventilation syncope) which are usually clinically unimportant, to
serious conditions (e.g. complete heart block, ventricular tachycardia) which,
if unrecognized, may result in fatality. Today's syncope may represent
tomorrow's sudden death.
Syncopal attacks are transient, so patients are usually seen when recovered
and the cause often is not apparent. There is a high spontaneous resolution
rate in up to two thirds of untreated patients with syncope. In the same
patient, the repetitions of syncope may have more than one cause. One
should be aware that simply finding an obvious cause (e.g. postural hypo
tension secondary to overmedication) should not stop the search for other
1
E. Andries, P. 8rugada & R. Stroobandt (eds.), How to face 'thejaces' afcardiac pacing. 1-21.
© 1992 Kluwer Academic Publishers, Dordrecht
