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Study population: We observed 102 pts (27 women, 75 men) aged 38-71
yrs, with suspected sinus node dysfunction.
Methods: based on results of rapid atria1 stimulation before and after pharmacological blockade with proprmolol and atropine (PB) all pts were divided
into 4 groups: group I - 32 pts without electrophysiological signs of SND,
Group II - 23 pts. with only decrease intrinsic heart rate (MR), group III 19 pts. with functional SND and group IV - 28 pts with organic SND. All
pts shows sinus rhythm in standard ECG. Before rapid atria1 stimulation, rapid
injection of 12 mg adenosine (Adenocor), followed by 20 cm3 of isotonic
natrium saline solution, was done in all pts. Mean PP before injection (P-PO),
maximal PP (maxF-PAd) and corrected maximal PP (AP-PAd = [maxF-PAd] [P-PO]) after b&s of adenosine were evaluated. All assessed parameters were
compared between groups.
Results: Values of evaluated parameters shows in table 1.
Table 1
Parameters
Groups
1
[msl
[msl
[msl
maxP-P.&i
AP.PM
824,88
999,09
174,22
11
852,SO
1124,60*
271,SO
P “able
1”
1”
987,53*
1214,63*
227,ll
956,07*
1258,93*
302,86*
*p<o,ooo1
*p<o,ooo1
*p<o,ooo1
Value of P-PO was signiiicantly higher in pts with functional and organic
SND (groups III and Iv) than in pts from group I. Maximal PP interval recorded
after Adenosine injection was signiiicantly higher in all SND pts in comparison
to the healthy people. Corrected maximal PP (AP-PAN) was higher than in
healthy persons, only in pts with organic SND (group Iv).
Conclusions: 1. Prolongation of P-P interval after rapid adenosine injection
was higher in patients with sinus node dysfunction than in healthy persons.
2. Significant prolongation of corrected maximal P-P interval after adenosine
administration was observed only in patients with organic sinus node dysfunction. 3. Rapid adenosine injection may be very useful in the diagnosis of sinus
node dysfunction.
I
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PRELIMINARY
RESULTS OF PITAGORA STUDY SHOW
A CLINICAL IMPROVEMENT
IN PATIENTS AFFECTED
BY SICK SINUS SYNDROME AND TREATED BY DDDRP
PACING
M. Gulizia, S. Mangiameli, V Indelicate, G. Butera, R. Evola, A. Circa,
C. Vasco, A. Di Girolamo, S. Or@ A. Battaglia, A. Grammatico. San Luigi
S. Curro Hospital,
Garibaldi
Hospital,
Civili Riuniti Hospital,
Clinica Noto
Pasqualino
Hospital,
S. Vincenzo Hospital,
Vittorio Emanuele Hospital,
Umberto I Hospital,
San Antonio Abate Hospital,
San Camille De Lellis, Villa
Sojia Hospital,
Medhonic
Italy
Background: Several therapeutical approaches have been proposed for the
treatment of drug refractory paroxysmal atria1 fibrillation (PAF) in patients
(pts) with sick sinus syndrome (SSS).
Aim: PITAGORA study is a prospective trial designed to evaluate the role
of DDDRP pacing, based on prevention algorithms (PrA1) and antitachycardia
pacing (ATP) therapies, in preventing PAF.
Methods: 118 pts (47 M, mean age 71&9 years) with SSS and PAF (at
least 3 symptomatic episodes per year) were implanted with the Medtronic
AT500TM pacemaker (PM). At first month, pts were inserted into a single-blind
crm~over evaluation. PrAl and ATP features were programmed OFF in the first
4 months and ON in the following 8 months. At follow up visits, performed
every 4 months, quality of life (QoL) EUROQOL questionnaire and Symptom
Checklist questionnaire were submitted. AAD therapy was maintained stable
after implant.
Results: 45 pts reached 13 month-follow up and were analysed. The number
of hospitalization per year decreased from 1.9&1.1 (pre-implant) to l.O&O.O
(post-implant, P<O.O5). Hospitalization duration decreased from lO.l&S.l (preimplant) to 4.6&6.8 (post-implant, P<O.O5). Data about number of symptomatic
patients, number of symptoms and QoL are shown in the following table.
Baseline
52+15
QoL
I
P 500
COMPARATIVE
EFFICACY OF BOLUS INTRAVENOUS
ATP AND ADENOSINE ON SINUS AND AV NODAL
FUNCTION
H. Heidbuchel, N. van da Menve, .I. Adams, S. Foulon, H. Goethals,
University
ofleuven,
R. Willems, H. Ector. University Hospital Gasthuisberg,
Leuvq
DDDR
DDDRP
Numberof pts with symptomaticepisodes(%) 455w (100%) 38W (84.4%) 3OW (66.7%)
Numberof symptoms
2.2H.O
1.4H.2 i
0.9+0.8*
64+14 i
69+11*
i P~~~~~~el~P~O.~lYBb~~%~
~&‘~vention
and antitachycardia
pacing algorithms significantly reduced the number of pts with symptomatic
episodes and the number of symptoms, furthermore signiiicantly improved
QoL. In comparison with pre-implant, the number of hospitalization per year
and in-hospital stay significantly decreased post-implant.
Belgium
Background: Intravenous adenosine (Ado) and adenosine-5’.triphosphate
(ATP) are often used for the diagnosis and treatment of tachyarrhythmias.
Their use has also been advocated -based on quantification of their effects- for
the detection of sick sinus syndrome or for paroxysmal AV block in patients
(pts) with unexplained syncope. Data about their comparative effects are scarce
however. Molar equipotency is expected for 6 mg Ado and 10 mg ATP.
Methods: We administered 6 mg Ado (Adenocor’) or 10 mg ATP
(S&dyne”)
to 21 pts (38&17y; 7 men) undergoing an electrophysiological study for supraventricular arrhythmias (SVT. The drugs were diluted into
10 cc saline, and injected as a b&s into the femoral vein via a 7 Fr sheath. In
11 pts a sequence of ATP-Ado-ATP was administered (with 5 min intervals),
and in 10 pts Ado-ATP-Ado.
Results: The baseline values of sinus cycle length and AH interval were
similar before each test. Latency between bolus injection and first cardiac effect
was also identical for Ado and ATP (18&3s vs. 17.8&3s). The duration of the
6 mg Ado effect however was signiiicantly shorter than that of 10 mg ATP
(7.0H.8
vs. 9.9&2.2s;
p<O.OOOl), and its cardiac effects were much weaker
with less blocked P-waves (OS&l.3 vs. 2.2&1.9, p<O.OOOl), shorter maximal
AH interval (149&75 vs. 203&90 ms, p<O.OOl), and shorter maximal R-R
interval (1X&2.2 vs. 2X&2.0 s, p<O.OOOl). One or more blocked P-waves
occurred in only 7 out of 31 Ado injections (23%) vs. 25 of 31 (81%) with
ATP (p<O.OOOl). All effects were reproducible, during both sequences.
Conclusions: Although roughly equimolar, the potency of 6 mg pharmaceutical Ado is signiiicantly less than that of 10 mg ATP. A starting dose of 3
mg Ado for conversion of SVT may be too low for most pts. Extrapolation of
quantitative test results with one drug cannot mathematically be extrapolated
to the other, but require independent validation.
I
P 502
PREVENTIVE TREATMENT
CARDIAC SURGERY
ON ARRHYTHMIAS
IN
0. Kalejs, R. La&, .I. Jirgensons, U. Strazdins, N. Porite, E. Strike,
V Harlamovs, J.J. VoIkolakovs, G. Cunska. PShadins
University
Surgery Latvian
Center of Cardiology
Center of Cardiovascular
Hospital,
Riga, Latvia
The aim of study was to observe the effectiveness of prophylactic treatment of
arrhythmias after cardiac surgery low dose amiodarone [amio] concomitantly
with miocardial protective agents.
Methods: The study group was divided into two parts: gr.1 - 188 pts received amio 400 mgidaily only 7 days before coronary surgery and amio 600
mgidaily intravenously first three days and 400 mgidaily only next four days
after coronary surgery. In group I. were included two subgroups - IA. received
only amio (92 pts.) and IB. (96 pts.) was used also trimethazidine 60 @daily
10 days before/l0 days after procedure. Gr II - 204 pts did not receive amio
in this period. Both groups received standard drug therapy before and after
surgery according to methods used in clinic.
Results are presented in the table. In subgroups IA and IB clinical symptoms were observed in correct differences, but in gr. IB totaly postoperative
arrhythmias were observed with less rare than in gr.IA. Pts. in gr.IB had more
fast early rehabilitation period and more better heart functions operation.
Postoperative AF total
Shortparoxysms<l hours
Paroxysms >3 hours
Paroxysmal Atria1 Flutter
Progressive angina pectoris
ProgressiveCHF (arrhythmogenic)
Acute rhythm disturbances(VT, VF)
Fatalcomplications
Durationof hospitalisation(days)
Group 1
Group ”
26%
16%
9%
10%
3%
9%
2%
0.9%
7+2
48%
34%
17%
19%
6%
22%
6%
2.2%
10+2
Conclusions: Arrhythmias after CABG were often postoperative complications. Administration of amiodarone before CABG procedures decreased
B184
Europace Supplements,
Vol. 4, December
2003