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1. Long-term effect of cardiac pacing on sleep-disordered breathing in patients with conventional indications for a permanent pacemaker

Author

Kohei Matsushita, MD, Toshiyuki Ishikawa, MD, Noritaka Toda, MD, Shinnichi Sumita, MD, Katsumi Matsumoto, MD, Junya Hosoda, MD, Yuuichirou Kimura, MD, Yutaka Ogino, MD, Yuka Taguchi, MD, Tomoaki Ishigami, MD, Teruyasu Sugano, MD, and Satoshi Umemura, MD

Subjects
Sleep apnea syndrome, Atrial fibrillation, Sick Sinus Syndrome, Atrio-ventricular block, Polysomnography, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract

Background: The effect of cardiac pacing on sleep-disordered breathing is controversial. We investigated the long-term effect of cardiac pacing on sleep disordered breathing in patients with conventional indications for permanent pacemakers Methods: Subjects comprised 40 patients (29 men; mean age 69±9 years, mean left ventricle ejection fraction 69±8%, and body mass index 23.6±3.5 kg/m2) who were diagnosed with indications for permanent pacemakers (sick sinus syndrome in 23 patients, atrioventricular block in 15, and brady atrial fibrillation in 2). All patients received polysomnographic evaluations before implantation of permanent pacemakers. After implantation of permanent pacemakers, all patients received polysomnographic evaluations during use of the pacemaker settings (AAI/DDD/VVI at 70 beats per minute). Results: The mean follow-up period was 35±13 months. Before implantation, the distribution of sleep-disordered breathing was as follows: 93% had apnea hypopnea index >5, 58% had apnea hypopnea index >15, and 20% had apnea hypopnea index >30. The mean apnea hypopnea index for all patients was 20±15, for those with obstructive type apnea was 4.9±5.3, and for those with central type apnea was 3.0±4.5. The mean Epworth Sleepiness Score was 5.9±4.0. No patient received continuous positive airway pressure therapy or any other therapy for sleep-disordered breathing during the follow up period. The mean apnea hypopnea index at 1 week after implantation of permanent pacemakers was 21±14 (P=0.8) and the mean apnea hypopnea index at end of follow-up was 11±7 (P

Published
2014
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2. Long-term Effect of Dual-chamber Pacing on Pressure Gradient at Left Ventricular Outflow Tract in Hypertrophic Obstructive Cardiomyopathy

Author

Junya Hosoda, MD, Toshiyuki Ishikawa, MD, Yohei Yamakawa, MD, Kohei Matsushita, MD, Katsumi Matsumoto, MD, Mihoko Miyamoto, MD, Teruyasu Sugano, MD, Tomoaki Ishigami, MD, Kazuaki Uchino, MD, Kazuo Kimura, MD, and Satoshi Umemura, MD

Subjects
Hypertrophic obstructive cardiomyopathy, Ventricular pacing, Right ventricular apex, Sinus rhythm, Catheterization study, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract

A 60-year-old man with hypertrophic obstructive cardiomyopathy (HOCM) was implanted dual-chamber ICD for the purpose of both the left ventricular outflow tract (LVOT) gradient reduction by ventricular pacing and the primary prevention of ventricular tachyarrhythmia. Because the LVOT gradient reduction and improvement of symptoms by pacing were insufficient, however, a new pacing lead was inserted in the right ventricular apex at a different position 1.5 cm away from the site of the defibrillation lead, and the LVOT gradient greatly declined from 108 to 30 mmHg. This DDD pacing was continued over seven years. On this occasion, he was referred to our hospital because of battery depletion, and a cardiac catheterization study was performed after ICD replacement. The LVOT gradient was 10 mmHg in sinus rhythm. After administration of isoproterenol (0.02γ), the gradient was increased to 92 mmHg in sinus rhythm. DDD pacing using a newly placed ventricular pacing lead significantly decreased the gradient to 36 mmHg. This case study indicated that DDD pacing from a suitable location in the right ventricular apex caused a marked early reduction in the LVOT gradient, and at long-term follow up a further significant effect was obtained, also in sinus rhythm.

Published
2011
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3. Changes of Sympathetic Activity in Patient with Chronic Atrial Fibrillation and Severe Congestive Heart Failure Treated with Biventricular Pacing

Author

Kohei Matsushita, MD, Toshiyuki Ishikawa, MD, Shinichi Sumita, MD, Tsukasa Kobayashi, MD, Hideyuki Ogawa, MD, Noriko Inoue, MD, Katsumi Matsumoto, MD, Minoru Taima, MD, Ichirou Nakazawa, MD, Teruyasu Sugano, MD, Tomoaki Ishigami, MD, Kazuaki Uchino, MD, Kazuo Kimura, MD, and Satoshi Umemura, MD

Subjects
Cardiac resynchronization therapy, Pacemaker, Autonomic nervous system, Hypertrophic cardiomyopathy, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract

The patient was a 64-year-old man with chronic atrial fibrillation with bradycardia. Left ventricular ejection fraction was 34%. He was treated with biventricular pacing. Heart failure improved from NYHA class III to II. Sympathetic nerve activity (SNA. was recorded during 6 minutes of biventricular (BV), right ventricular apical (RVA. and left ventricular (LV. pacing. SNA was significantly lower during biventricular pacing (49.5 ± 4.0/min. compared with RVA (58.8 ±6:9/min, p = 0.016. and LV (63.3 ± 4.3/min, p = 0.002. pacing. BV pacing improves hemodynamics and decreases SNA compared with RVA or LV pacing.

Published
2006
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4. Inverse Relation between Condition of Heart Failure and Intrathoracic Impedance Measured by Implantable Cardioverter Defibrillator—A case report—

Author

Kohei Matsushita, MD, Toshiyuki Ishikawa, MD, Shinichi Sumita, MD, Tsukasa Kobayashi, MD, Hideyuki Ogawa, MD, Noriko Inoue, MD, Katsumi Matsumoto, MD, Minoru Taima, MD, Ichirou Nakazawa, MD, Teruyasu Sugano, MD, Tomoaki Ishigami, MD, Kazuaki Uchino, MD, Kazuo Kimura, MD, and Satoshi Umemura, MD

Subjects
Electric countershock, Monitoring, Physiologic (thoracic impedance), Pulmonary edema, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract

The patient was a 78-year-old man with dilated cardiomyopathy. His cardio-thoracic ratio was 60.4% and left ventricular ejection fraction (LVEF) was 33%. He had been repeatedly admitted for congestive heart failure. He underwent implantation of an implantable cardioverter-defibrillator (ICD) for ventricular fibrillation. We compared the values of BNP and shock impedance stored by the ICD. The correlation coefficient (p-value) between BNP and shock impedance was −0.700 (p < 0.0005), increase of BNP and shock impedance was −0.778 (p < 0.0001), percent increase of BNP and shock impedance was −0.767 (p < 0.0005). In conclusion, there is an inverse relation between BNP and shock impedance, and measurements of shock impedance may be useful in the management of congestive heart failure.

Published
2005
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