Atrial Ganglionated Plexus Modification: A Novel Approach to Treat Symptomatic Sinus Bradycardia.

OBJECTIVES: This study sought to determine if anatomic atrial ganglionated plexus (GP) ablation leads to long-term sinus rate (SR) increase and improves quality of life in patients with symptomatic sinus bradycardia (SB). BACKGROUND: Atrial GP ablation has been demonstrated to increase SR in our previous study. Atrial GP ablation may also be effective in treating patients with symptomatic SB. METHODS: Sixty-two patients with symptomatic SB were recruited: Group A included patients <50 years of age (n = 40); Group B included patients ≥50 years of age (n = 22). All patients underwent anatomic ablation of the main atrial GP, and 24-h Holter monitoring and quality-of-life assessment were performed during 1 year of follow-up. Quality of life was accessed by the Medical Outcomes Study Short-Form 36 Health Survey. RESULTS: Although SR markedly increased in all patients after GP ablation, the increase was significantly greater in patients <50 years of age than in patients ≥50 years of age (19.3 ± 9.9 beats/min vs. 10.8 ± 5.4 beats/min; p = 0.001). The right anterior GP and the GP at the junction of the aorta and superior vena cava made the greatest contributions to SR increase among all GP. The mean and minimal SR increased significantly after ablation and remained elevated for 12 months only in Group A patients. Although symptoms and quality of life improved in all patients, 5 of the 8 domains of the Medical Outcomes Study Short-Form 36 Health Survey did not show obvious improvements in patients of Group B at 12 months. CONCLUSIONS: Anatomic atrial GP ablation effectively increased SR and improved quality of life in patients <50 years of age with symptomatic SB.

Pain site frequency and location in sickle cell disease: the PiSCES project.

Treatment options for sickle cell disease (SCD) pain could be tailored to pain locations. But few epidemiologic descriptions of SCD pain location exist; these are based on few subjects over short time periods. We examined whether SCD pain locations vary by disease genotype, gender, age, frequency of pain, depression, pain crisis or healthcare utilization. We enrolled 308 adults with SCD in 2002-2004. Subjects kept daily pain diaries for up to 6months, including a body chart. Mixed model and generalized estimating equations were employed for analyses. Two hundred and sixty subjects completed at least one body chart. An average of 3.3/16 sites (25%) were painful. The number of pain sites varied by age, depression, frequent pain days, crisis and unplanned hospital/ED utilization. Lower back, knee/shin and hip, hurt on average more than a third of pain days, while jaw and pelvis hurt on fewer than 10% of days. Odds of a crisis were increased substantially when pain was in the arm, shoulder, upper back, sternum, clavicle, chest or pelvis (OR>1.5) while the odds of unplanned utilization were substantially increased for the sternum, clavicle and chest (OR>2.0). Pain in SCD varies considerably both within and between subjects, although it occurs most commonly in the lower back and lower extremities. The number and location of pain sites vary significantly by age, frequent pain, crisis and utilization. Identification and understanding of combinations of pain location and intensity may help to understand the etiology of SCD and improve SCD management.

Atrial fibrillation and quality of life after pacemaker implantation for sick sinus syndrome: data from the Mode Selection Trial (MOST).

BACKGROUND: In the Mode Selection Trial (MOST) of 2,010 patients with sinus node dysfunction, dual-chamber-paced patients had less atrial fibrillation (AF) and heart failure and had slightly improved health-related quality of life (QOL) compared with rate modulated right ventricular-paced patients. Our objective was to assess the impact of AF on QOL within MOST. METHODS: We analyzed serial QOL measures (Short Form-36, Specific Activity Scale, time trade-off) in 3 groups: (1) those without AF; (2) those with paroxysmal AF (PAF), but not chronic AF (CAF); and (3) those with CAF. We carried forward the last known QOL before crossover for all subsequent time points in patients randomized to rate modulated right ventricular pacing who crossed over to dual-chamber pacing for severe pacemaker syndrome. RESULTS: Three hundred seventeen patients (15.8%) had AF in the year after implantation, 206 patients within 3 months (191 PAF, 15 CAF), and another 159 (124 PAF, 35 CAF) between 3 and 12 months. There were no significant differences among groups in individual Short Form-36 subscales or time trade-off scores at 12 months as compared with baseline or 3 months. Cardiovascular health status was better at 12 months as compared with baseline or 3 months in those without AF. CONCLUSIONS: Atrial fibrillation after pacemaker implantation in elderly patients with sick sinus syndrome was not a major determinant of QOL. However, there was a trend toward better cardiovascular functional status in patients without AF.

Changes in the mental and physical components of the quality of life for patients six months after pacemaker implantation.

BACKGROUND: The additional purpose for pacemaker implantation, beyond treating arrhythmias and conduction disturbances, is to improve the quality of life (QoL) of the patient. Most previous research has shown this purpose to have been achieved. However, the question as to whether all mental and physical components improve QoL to the same degree is still valid. The purpose of this study is to evaluate changes in the primary mental and physical areas of QoL in patients six months after they have had a pacemaker implanted. METHODS: Ninety eight patients with atrioventricular blocks (AVB) and 100 patients with sinus node dysfunction (SND) who were qualified for pacemaker implantation were included in this study. Every patient had a DDD(R)-type pacemaker with bipolar screw-in leads implanted. The ventricular lead was positioned in the right ventricular outflow tract. QoL was evaluated twice: three to five days before implantation and six months afterwards - the MLWHF questionnaire was used. RESULTS: A very high statistical improvement in QoL (p approximately 0,0000) - reduced number of points was found in all five areas of QoL in patients with SND and in four areas in patients with AVB. In the 'anxiety/depression area' in patients with AVB, the average number of points was higher (p = 0.3871), so QoL was worse. CONCLUSIONS: Implanting a pacemaker improves QoL in patients with AVB and SND. In patients with AVB, anxiety/depression is made more intense.

Self-care in adults with sickle cell disease.

This article summarizes the psychometric evaluation of the Chronic Illness Assessment Interview for Sickle Cell Disease (CIAI-SCD), an instrument based on a model of self-care for adult patients with chronic medical conditions. The CIAI-SCD was administered to 104 adults with sickle cell disease. A factor analysis identified three factors that reflected the psychological constructs of Personal Satisfaction and Perceived Control (Factor 1), Feeling Concerned and Worried (Factor 2), and Feeling Supported (Factor 3). Preliminary evidence for the internal consistency, test-retest reliability content validity, and construct validity of the CIAI-SCD was obtained. After further refinement and validation, the CIAI-SCD may be a useful tool for assessing factors related to self-care skills among adults with sickle cell disease.

[Follow-up patients with sick sinus syndrome after pacemaker implantation]. / Rezul'taty dispansernogo nabliudeniia za bol'nymi s sindromom slabosti sinusovogo uzla posle implantatsii kardiostimuliatora.

AIM: To study a clinical course and dynamics of arrhythmogenesis in patients with sick sinus syndrome (SSS) in varying regimes of permanent pacing. MATERIAL AND METHODS: Of 223 SSS patients, the SSS course and outcomes under pacing were studied in 148 bradyarrhythmia and 75 bradytachyarrhythmia patients. ECG variants and pacing regimes were regarded. RESULTS: Within 4-13-year follow-up, constant form of supraventricular tachyarrhythmia was diagnosed in atrial stimulation in 3.4% of cases, in ventricular stimulation in 32%. Thromboembolic complications and atrioventricular blocks of the II-III degree in atrial stimulation were registered, respectively, in 5.6 and 4.2% cases. Thromboembolism in ventricular stimulation occurred in 11.1%. Reoperation (conversion from atrial to ventricular stimulation, ablation of atrioventricular conjunction) was made for change of pacing method and regime in 11.2% because of changed arrhythmia type. Total mortality for the follow-up period was 14.3%, in bradycardia--9.5%, in bradytachycardia--24%. CONCLUSION: Continuous pacing improves quality of life in SSS patients.