Outcomes after pacemaker implantation : Results of the followpace study

Ever since the first PM implantation in The Netherlands on january the 30th 1962 by cardiologist Dr Blom, Leiden University, there has been an almost continuous yearly increase of the numbers op PMs implanted in The Netherlands. In 2006 in the Netherlands, 9765 PM’s were implanted of which 6765 were first implants. The remaining included pacemaker replacements. In 2006, a total of 12853 leads were implanted of which 11819 were used as first implantations. A pacemaker implantation is now considered a routine procedure. Pacing therapy, however, does not end after implantation. Patients with an implanted pacing device enter a lifelong path of follow-up. The FOLLOWPACE study was designed as a nation-wide prospective cohort study among patients who received a PM for the first time executed among 24 pacemaker centers in The Netherlands. The incidence of in-hospital events after first PM implantation was 10.1 % (95 %CI: 8.9 %-12.3 %). Six variables i.e. a lower body mass index, presence of heart failure in medical history, main indication for implantation, vena subclavia use for venous access, passive atrial lead fixation, and the implantation of a dual chamber system were found to be independent predictors of these in-hospital events. We disclosed that, in general, crucial PM parameters are regularly checked and much attention is paid to the safety of cardiac pacing throughout the follow-up. Pacing stimulation and sensing thresholds as well as lead impedances and percentages of pacing remain stable over time but these values depend on the lead location, lead fixation, and pulse duration. Reprogramming of PM parameters declined during the first year after PM implantation. The majority of PM controls was carried out by a PM technician, indicating the influence of the allied professional on the quality and safety of chronic cardiac pacing. The Health related Quality of Life (HRQoL) measured just before first PM implantation was significantly lower than that of a general population. Gender, age and the presence of cardiovascular co-morbidities are clearly related to the quality of life before PM implantation. We found that the HRQoL of patients treated with a pacemaker for conventional indications improved considerably in the first year after implantation. Almost 70 % of patients considered their HRQoL much better or even completely recovered. We found that patients with extreme low or high BMI and patients with concomitant heart failure and other cardiovascular diseases were more likely to experience an events after PM implantation. Having had an in-hospital event further increased the risk for developing a PM therapy related event as well as a major non-fatal cardiac event (but not all cause mortality). Using the Vena subclavia as access point for cardiac entrance also increased the risk of a PM therapy related event

FOLLOWPACE study: a prospective study on the cost-effectiveness of routine follow-up visits in patients with a pacemaker

Aims This communication describes the design of the FOLLOWPACE study. The overall aim of FOLLOWPACE is to quantify the cost-effectiveness of routine follow-up visits in patients with a pacemaker (PM). Specific aims are (i) to quantify the incidence of complications and the quality of life 1 year after PM implantation; (ii) to quantify which baseline characteristics measured during implantation are predictors of the occurrence of complications and quality of life after 1 year; (iii) to determine the added predictive value of follow-up measurements to improve the efficiency of follow-up and to demonstrate which follow-up measurements are redundant. Methods and results FOLLOWPACE is a prospective, observational, prognostic cohort study. About 40 PM centres in the Netherlands will participate to include about 2500 patients. Each patient aged > 18 receiving a PM for the first time is eligible. At baseline, i.e. time of implantation, all potential predictors of complications and quality of life after 1 year are documented. After implantation, follow-up visits will be carried out conforming with routine care, usually three in the first year. At these visits, other potential prognostic predictors will be documented. Primary outcome is the incidence of PM- or cardiac complications at 1 year. Secondary outcome parameters are quality of life and costs after 1 year. Conclusion This study will lead to definition of a more efficient routine follow-up schedule for patients with a PM, aiming to reduce time and energy white preserving the safety of pacing therapy and the prognosis of the patient. The study will ultimately provide evidence-based guidelines for PM follow-up including knowledge of the responsibilities of cardiologists, technicians, and representatives of PM manufacturers

Effects of postural changes on cardiac function in healthy subjects

AIMS: To analyse the response of Doppler measurements to increased venous return in middle-aged healthy subjects. METHODS AND RESULTS: Left ventricular pulsed Doppler parameters, colour M-mode of early left ventricular filling and septal mitral annulus velocities were measured at baseline and after leg lifting (n=24). Leg lifting resulted in increased stroke volume (69 +/- 14 to 74 +/- 14 ml, P <0.01) and peak systolic annulus velocity (6.8 +/- 1.3 to 7.3 +/- 1.1 cm/s, P <0.01). Leg lifting enhanced peak early (E) mitral flow (74 +/- 13 to 80 +/- 14 cm/s, P <0.01), flow propagation (53 +/- 10 to 59 +/- 13 cm/s, P <0.01) and E' diastolic mitral annulus velocity (10.8 +/- 2.2 to 11.7 +/- 2.0 cm/s, P <0.01). There was a shortening of E wave deceleration time (178 +/- 27 to 163 +/- 27 ms, P <0.01) and isovolumic relaxation time (76 +/- 11 to 68 +/- 10 ms, P <0.01). However, individual changes in Doppler parameters differed among subjects. CONCLUSIONS: Leg lifting improved myocardial function as manifested by increase in stroke volume, systolic annulus motion and acceleration of relaxation. Flow propagation velocity and diastolic mitral annulus velocities were influenced by the induced change in cardiac preload as wel

Advances in Magnum-PSI probe diagnosis in support of plasma-surface interaction studies

Magnum-PSI is a linear plasma generator equipped with a superconducting magnet, assuring fusion devices relevant conditions at plasma–surface interface. The plasma column was diagnosed using 64 probes embedded in the target. The cross-sectional distributions of plasma parameters (floating potential, ion saturation current and electron temperature) were measured for hydrogen and deuterium plasmas under various discharge conditions. The radial profile of the floating potential across the plasma column can be described by a reversed Mexican hat-like wavelet, having the most negative potential at the center of the plasma column. The negativity of the floating potential diminishes when the discharge current increases or the magnetic field decreases. The axial gradient of the floating potential is reduced by increasing the magnetic field. The ion saturation current is maximum at the center of the plasma column, increasing with both the discharge current and magnetic field. The ion flux to the target, estimated from Thomson scattering (TS) data, was confirmed by probe measurements. The electron temperature estimated from the ion branch of the probe current-voltage characteristic is few times larger than that obtained from TS. By increasing the gas pressure in the target chamber, the time-dependent ion saturation current measured by probes changes from a constant average current (when the plasma column is attached to the target) to a fluctuating average current with scattered peaks (in a partially detached regime) which vanishes completely in the fully detached regime. With respect to hydrogen, the plasma column is wider in deuterium and is characterized by less negative floating potential distributions

Monitoring van de effecten van de verruiming 48'/43': MOVE-rapport 8, Deel B: Hoofdrapport

In 1995 kwamen Vlaanderen en Nederland overeen dat de vaargeul naar Antwerpen verruimd zou worden tot 48/43/38 voet. Dit betekent dat schepen met een maximale diepgang van 48 voet (1 voet is circa 0,3 meter) in één getij naar Antwerpen kunnen varen en dat schepen met een maximale diepgang van 43 voet in één getij vanuit Antwerpen de Westerschelde af kunnen varen. Schepen met een diepgang van 38 voet kunnen onafhankelijk van het getij op de Westerschelde varen. Het verruimingsverdrag voorziet naast de verruimingswerkzaamheden ook in wrakkenberging, aanleg van geulwandverdedigingen en een natuurcompensatieprogramma. Tussen juli 1997 en juli 1998 is deze vaarwegverruiming in de Westerschelde (kortweg de verruiming 48\u92/43\u92) uitgevoerd. Dit rapport beschrijft de evaluatie van de effecten van deze verruiming en de bijbehorende bagger-, stort- en zandwinstrategie. Beide evaluaties zijn gebaseerd op meetgegevens die ondermeer in het kader van het project MOVE (Monitoring Verruiming Westerschelde) zijn verzameld. MOVE is in 1996 door de beheerder van de Westerschelde, Rijkswaterstaat Directie Zeeland, opgezet en wordt in 2006 afgerond met een eindevaluatie. De MOVE evaluatierapportage 2003 is een tussenevaluatie en heeft de volgende doelstellingen: 1 Het signaleren van ontwikkelingen in de Westerschelde om daarmee de effecten van de verruiming 48\u92/43\u92 te evalueren. 2 Het evalueren van de effecten van de bagger-, stort- en zandwinstrategie. Hieronder staan de belangrijkste conclusies van de MOVE evaluatie 2003: - Waterstanden in het oostelijk deel zijn veranderd zoals verwacht - Morfologie, van met name platen en ondiep water, is veranderd, maar anders dan verwacht - Het MOVE Fysisch denkmodel lijkt te kloppen m.b.t. waterbeweging, maar niet voor de morfologie - Er zijn (nog) geen effecten t.g.v. verruiming 48'/43' waarneembaar m.b.t. biologie/ecologie - De waterkwaliteit is waarschijnlijk niet beïvloed door de verruiming 48'/43' - Behoud van het meergeulenstelsel bij het huidige vaarwegonderhoud is nog mogelijk - Er is geen relatie gevonden tussen de omvang van het onderhoudsbaggerwerk van de drempel en de omvang van het gestorte materiaal nabij de drempel - De toename van omvang onderhoudsbaggerwerk is vooral een gevolg van vaarwegverbreding - Westerschelde blijkt een zandexporterend systeem te zijn gewordenZeemov