Novel Form of Pacemaker Dysfunction with Intermittent Inhibition of Pacemaker Output
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ABSTRACTS Heart, Lung and Circulation Abstracts S115 2008;17S:S1–S209 274 Novel Form of Pacemaker Dysfunction with Intermittent Inhibition of Pacemaker Output Hany Abed ∗ , James Leitch, Malcom Barlow The John Hunter Hospital, Newcastle, NSW, Australia Introduction: We report a novel type of pacemaker mal- function related either to an intermittent pacemaker component failure or an interaction between pacemaker generator and pacemaker leads. Methods: Details of patients and devices are shown in the table below. Patients had received either Biotronik Actros or Biotronik Axios devices. Medtronic leads were used in all patients. Results: The mode of failure was intermittent inappropri- ate inhibition of device output. Most patients presented with either pre-syncope or frank syncope at the time of device malfunction. Device interrogation revealed either no abnormality or in one case transient elevation of lead impedance with normal sensing. The first patient under- went generator and lead replacement. The remaining four patients underwent generator replacement from a differ- ent manufacturer. Subsequently, no patient had further problems. The explanted devices were returned to the manufacturer for detailed analysis, but no abnormality was identified. Technical advice from the manufacturer suggested that this type of failure could result from incompatibility between the Biotronik generator and non- Biotronik leads. An alternative explanation is some form of intermittent generator component failure. Conclusions: Patients with Biotronik Axios and Actros devices should be reviewed closely for this unusual form of device malfunction. Device V Lead A Lead Implant duration Implant indication Symptom Pacemaker failure Patient 1, age 84 Biotronik Actros VVIR Medtronic 5024M – 40 months Slow atrial fibrillation Pre-syncope Impedance >3200 . No ventricular pacing Patient 2, age 68 Biotronik Axios DR Medtronic 5076 Medtronic 5076 36 months Complete heart block Syncope Intermittent complete inhibition of PPM output Patient 3, age 72 Biotronik Axios DR Medtronic 4524M Medtronic 4524 72 months Second degree AV block Syncope Complete inhibition of PPM output persisting for several hours Patient 4, age 67 Biotronik Actros DR Medtronic 5024M Medtronic 4524 75 months AV node ablation Detection on routine follow-up Intermittent inhibition of atrial and ventricular output Patient 5, age 77 Biotronik Axios DR Medtronic 5092 Medtronic 5594 42 months AV node ablation Pre-syncope Intermittent inhibition of ventricular output doi:10.1016/j.hlc.2008.05.275 275 Incidence and Prognostic Impact of New Onset Atrial Fib- rillation Varies with Acute Coronary Syndrome Severity Dennis H. Lau 1,∗ , Luan T. Huynh 2 , Derek P. Chew 2 , Carolyn M. Astley 2 , Ashish Soman 3 , Glenn D. Young 1 , Prashanthan Sanders 1 1 Cardiovascular Research Centre, Department of Cardiology, Royal Adelaide Hospital and the Disciplines of Medicine and Physiology, University of Adelaide, Adelaide, SA, Australia; 2 Department of Cardiology, Flinders University, Flinders Med- ical Centre, Adelaide, SA, Australia; 3 Sanofi-Aventis, Australia Introduction: Atrial fibrillation (AF) is a predictor of poorer outcome in acute coronary syndrome (ACS). However, whether its incidence and prognostic impact differs with the varying ACS severity is unknown. Methods: The Acute Coronary Syndrome Prospective Audit Study (ACACIA, PM L 0051) is a prospective multi-centre registry of 3402 patients involving 39 sites across Australia between November 2005 and June 2007 with 12-month outcome data in 3393 [755 ST elevation myocardial infarction (STEMI), 1942 high-risk (ACS-HR) and 696 intermediate-risk (ACS-IR) non-ST elevation ACS].Results: There were 149 (4.4%) new onset AF (nAF) and 387 (11.4%) with a past history of AF (phxAF). nAF was most while phxAF was least frequent in STEMI vs. ACS-HR and ACS-IR (6.5 vs. 4.6 and 1.6% and 5.2 vs. 14.6 and 9.3% respectively; P < 0.001). Both nAF and phxAF patients were older with more heart failure at presentation as compared to those without arrhythmia (CTL) (P < 0.004). nAF patients were discharged on more new medications (P < 0.03) and had longer hospitalisations (P < 0.001) vs. CTL and phxAF patients. nAF but not phxAF, was asso- ciated with worse overall long term composite outcome of deaths, myocardial infarction and stroke (adjusted HR 1.7, P = 0.004). There was a trend in higher prognostic burden of nAF in those with unstable angina vs. non- STEMI and STEMI (adjusted OR 3.9 vs. 2.0 and 1.4; P < 0.03).Conclusions: nAF was more common in those with greater severity of ACS but its prognostic impact was higher in the less severe ACS spectrum. Only nAF was predictive of long-term adverse outcomes. doi:10.1016/j.hlc.2008.05.276
Transcript of Novel Form of Pacemaker Dysfunction with Intermittent Inhibition of Pacemaker Output
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Heart, Lung and Circulation Abstracts S1152008;17S:S1–S209
274Novel Form of Pacemaker Dysfunction with IntermittentInhibition of Pacemaker Output
Hany Abed ∗, James Leitch, Malcom Barlow
The John Hunter Hospital, Newcastle, NSW, Australia
Introduction: We report a novel type of pacemaker mal-function related either to an intermittent pacemakercomponent failure or an interaction between pacemakergenerator and pacemaker leads.Methods: Details of patients and devices are shown in thetable below. Patients had received either Biotronik Actrosor Biotronik Axios devices. Medtronic leads were used inall patients.Results: The mode of failure was intermittent inappropri-ate inhibition of device output. Most patients presentedwith either pre-syncope or frank syncope at the time ofdevice malfunction. Device interrogation revealed eitherno abnormality or in one case transient elevation of leadimpedance with normal sensing. The first patient under-went generator and lead replacement. The remaining fourpatients underwent generator replacement from a differ-ent manufacturer. Subsequently, no patient had furtherproblems. The explanted devices were returned to themanufacturer for detailed analysis, but no abnormalitywas identified. Technical advice from the manufacturersuggested that this type of failure could result fromiBoCdo
nt dur
P nths
P nths
P nths
P nths
P nths
d
275Incidence and Prognostic Impact of New Onset Atrial Fib-rillation Varies with Acute Coronary Syndrome Severity
Dennis H. Lau 1,∗, Luan T. Huynh 2, Derek P. Chew 2,Carolyn M. Astley 2, Ashish Soman 3, Glenn D. Young 1,Prashanthan Sanders 1
1 Cardiovascular Research Centre, Department of Cardiology,Royal Adelaide Hospital and the Disciplines of Medicine andPhysiology, University of Adelaide, Adelaide, SA, Australia;2 Department of Cardiology, Flinders University, Flinders Med-ical Centre, Adelaide, SA, Australia; 3 Sanofi-Aventis, Australia
Introduction: Atrial fibrillation (AF) is a predictor of pooreroutcome in acute coronary syndrome (ACS). However,whether its incidence and prognostic impact differs withthe varying ACS severity is unknown.Methods: The Acute Coronary Syndrome ProspectiveAudit Study (ACACIA, PM L 0051) is a prospectivemulti-centre registry of 3402 patients involving 39 sitesacross Australia between November 2005 and June 2007with 12-month outcome data in 3393 [755 ST elevationmyocardial infarction (STEMI), 1942 high-risk (ACS-HR)and 696 intermediate-risk (ACS-IR) non-ST elevationACS].Results: There were 149 (4.4%) new onset AF (nAF)and 387 (11.4%) with a past history of AF (phxAF). nAFwas most while phxAF was least frequent in STEMI vs.ACS-HR and ACS-IR (6.5 vs. 4.6 and 1.6% and 5.2 vs.1pan(
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ncompatibility between the Biotronik generator and non-iotronik leads. An alternative explanation is some formf intermittent generator component failure.onclusions: Patients with Biotronik Axios and Actrosevices should be reviewed closely for this unusual formf device malfunction.
Device V Lead A Lead Impla
atient 1, age 84 Biotronik ActrosVVIR
Medtronic 5024M – 40 mo
atient 2, age 68 Biotronik AxiosDR
Medtronic 5076 Medtronic 5076 36 mo
atient 3, age 72 Biotronik AxiosDR
Medtronic 4524M Medtronic 4524 72 mo
atient 4, age 67 Biotronik ActrosDR
Medtronic 5024M Medtronic 4524 75 mo
atient 5, age 77 Biotronik AxiosDR
Medtronic 5092 Medtronic 5594 42 mo
oi:10.1016/j.hlc.2008.05.275
ation Implant indication Symptom Pacemaker failure
Slow atrial fibrillation Pre-syncope Impedance >3200 �. Noventricular pacing
Complete heart block Syncope Intermittent completeinhibition of PPM output
Second degree AV block Syncope Complete inhibition of PPMoutput persisting for severalhours
AV node ablation Detection onroutinefollow-up
Intermittent inhibition ofatrial and ventricular output
AV node ablation Pre-syncope Intermittent inhibition ofventricular output
4.6 and 9.3% respectively; P < 0.001). Both nAF and phxAFatients were older with more heart failure at presentations compared to those without arrhythmia (CTL) (P < 0.004).AF patients were discharged on more new medications
P < 0.03) and had longer hospitalisations (P < 0.001) vs.
TL and phxAF patients. nAF but not phxAF, was asso-iated with worse overall long term composite outcomef deaths, myocardial infarction and stroke (adjusted HR.7, P = 0.004). There was a trend in higher prognosticurden of nAF in those with unstable angina vs. non-TEMI and STEMI (adjusted OR 3.9 vs. 2.0 and 1.4;< 0.03).Conclusions: nAF was more common in thoseith greater severity of ACS but its prognostic impact wasigher in the less severe ACS spectrum. Only nAF wasredictive of long-term adverse outcomes.
oi:10.1016/j.hlc.2008.05.276
