C.M.C. van Campen

Comparison of the haemodynamics of different pacing sites in patients undergoing resynchronisation treatment: need for individualisation of lead localisation

Background: Biventricular pacing is a new therapy for the treatment of heart failure. However, a substantial number of patients do not respond to this therapy. Hypothesis: Individually determined maximal pacing sites will improve the haemodynamic response and increase the number of responders. Methods: In 48 patients with heart failure, the acute haemodynamic effects of nine different pacing configurations were studied, using two right and left ventricular pacing sites and their combinations. Cardiac index was measured using Doppler echocardiography. For further analysis, the combination with the highest cardiac index improvement was compared with baseline. Moreover, the number of responders was calculated using a cut-off value of 10% increase in cardiac index. Results: The mean (SD) increase in cardiac index ranged between 3.8% (6.0%) and 11.1% (8.6%). The pacing site with maximal cardiac index was highly variable between patients, and here the cardiac index increased to 14.8% (7.6%; (p<0.001). The number of responders varied between 15% and 64%, increasing to 75% at the site with maximal increase in cardiac index. In a subset of patients, the haemodynamic improvement after pacemaker implantation correlated well with the acute haemodynamics. Conclusion: Individualisation of pacing configuration for biventricular pacing leads to further haemodynamic improvement in patients with heart failure and reduces the number of patients not responding to this therapy.

Effect of homocysteine-lowering vitamin treatment on electrocardiography stress tests in a randomized, placebo-controlled trial: comparison between ST-segment changes and athen QRS-score

E.G.J. Vermeulen*, M.I.A. van Engeland, F.C. Visser, C.D.A. Stehouwer, J.W.R. Twisk, C.M.C. van Campen, J.A. Rauwerda Department of Surgery, Vascular Surgical Unit, VU University Medical Center, Amsterdam, The Netherlands Department of Cardiology, VU University Medical Center, Amsterdam, The Netherlands Department of Internal Medicine, VU University Medical Center, Amsterdam, The Netherlands d Institute for Cardiovascular Research ‘‘Vrije Universiteit’’ (ICaR-VU), Amsterdam, The Netherlands e Institute for Research in Extramural Medicine (EMGO), Amsterdam, The Netherlands

Left Atrial‐ and Left Ventricular‐Based Single Lead DDD Pacing

DE COCK, C.C., et al.: Left Atrial‐ and Left Ventricular‐Based Single Lead DDD Pacing. Single lead physiological pacing with right ventricular apex stimulation is feasible in patients with normal sinus node function and is associated with lower costs and a reduced complication rate. Left ventricular or biventricular pacing using the tributaries of the coronary sinus was reported to improve functional status and quality‐of‐life in patients with advanced congestive heart failure and intraventricular conduction delays. In addition, the proximal part of the coronary sinus has been successfully used for left atrial stimulation. The feasibility and pacing characteristics of left atrial‐ and left ventricular‐based temporary pacing using a conventional single pass lead were studied. The tip of the lead was advanced in a distal position of the lateral or posterolateral branches of the coronary sinus, providing a stable position of the middle and proximal electrode pair in the first 2–7 cm of the coronary sinus. A successful stable position was achieved in 13 of 21 consecutive attempts. Using overlapping biphasic (OLBI) stimulation, left atrial and left ventricular pacing threshold were 2.3 ± 0.6 and 2.5 ± 0.5 V, respectively. Acceptable sensing values were measured for P waves (4.1 ± 0.7 mV) and R waves (9.7 ± 3.9 mV). There was a good correlation between the diameter of the coronary sinus as assessed by quantitative coronary angiography at the level of the middle and proximal rings and atrial pacing threshold (r = 0.92, P < 0.0001). Thus, single lead left atrialand left ventricular‐based pacing is feasible although further development is necessary to increase the success rate for stable stimulation at both sites.

Quantification of the Beneficial Effects of Compression Stockings on Symptoms of Exercise and Orthostatic Intolerance in Chronic Fatigue Syndrome/Myalgic Encephalomyelitis Patients

Chronic fatigue syndrome and myalgic encephalomyelitis (CFS/ME) are, amongst others, characterized by exercise intolerance, pain, post exertional malaise and orthostatic intolerance. It has been shown in venous disease and sport participation that compression stockings may improve exercise performance and reduce post exercise muscle soreness. Moreover, its use is advocated in orthostatic hypotension. Therefore, it was hypothesized that compression stockings may reduce symptomatology in CFS/ME patients. Methods: 100 patients used compression stockings class II for minimally 3 weeks and thereafter filled in a questionnaire, based on the Rand 36 physical activity questions (n = 9), whether compression stockings changed perceived symptoms or not. Moreover, 7 questions referring to prolonged standing and sitting, to recovery post exercise, muscle pain during or immediately post exercise, and to dizziness/light-headedness during or immediately post exercise, while standing and during prolonged sitting were added. Questions were scored as 1: able to perform activity much less while wearing the stockings, 2: perform activity somewhat less, 3: no perceived change in activity, 4: perform activity slightly better, 5: able to perform activity much better while wearing the stockings. Results: In patients able to answer the question, all mean scores per activity were significantly higher than 3, being no perceived change in activity while wearing the stockings. Subgroup analysis showed that patients with orthostatic intolerance reported higher effects than patients without orthostatic intolerance. Conclusion: This pilot study suggests that compression stockings may be useful to reduce symptomatology of physical activities in CFS/ME patients, especially in patients with orthostatic intolerance. Larger prospective studies with hard endpoints are warranted.

Cerebral blood flow changes during tilt table testing in healthy volunteers, as assessed by Doppler imaging of the carotid and vertebral arteries

Highlights • Extracranial cerebral artery Doppler imaging show CBF changes during tilt testing.• Total CBF during tilt testing decreases 6% in healthy volunteers.• Flow decrease of internal carotid and vertebral arteries during tilting is similar.