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EUROPACE 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 P 501 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