Chronotropic-incompetence.eu

With AutoLifestyle™ – my patient is now able to perform her daily activities.
Minute Ventilation has definitely improved her quality of life.
Patient:
A 68 years old woman with intensive daily activities. The patient takes care of her family. She lives at home with her son and her three grandchildren. The patient needs appropriate heart rate to be able to cover all in-house activities.
Indications:
Hypertensive Cardiopathy, AF episodes. NYHA Class I-II. Hypercholesterolemia. Treated Primary Hyperthyroidism. In 1999, she went to the hospital due to an AV Node heart block - drug-induced. After having stopped drugs, she reverted to Sinus Rhythm followed by AF with rapid ventricular response. Finally, she went through an AV Node ablation with a pacemaker implantation (October 21st, 1999, SSIR Pacesetter).
Medications:
Amiodarone, Acovil, Tenormin, Adiro, Neotomizol, Nitroderm.
Device Programming:
Replacement with ALTRUA™ 60 SR (S601). The physician was interested in testing the capabilities of the ALTRUA™ MV Blended sensor and assessing the ability to restore chronotropic competence for his patients. A “step by step” protocol was performed with the Physician/Nurse to show how ALTRUA™ can help in identifying and treating the CI Patient. Implant on June, 11th
The patient left the hospital with both sensors OFF.
Implanting Physician:
Dr. Juan Leal del Ojo, Hospital Universitario Virgen de Valme, Sevilla, Spain.
First Follow-up on June, 16th
One week after the device implant, the following information was retrieved from the ALTRUA™ pacemaker: – Activity log: • Percent of day active 0 Exercise intensity Chronotropic Incompetence 1 Case Study 9
The daily activity log showed a reasonable level of exercise intensity but
the patient kept complaining about fatigue and being often exhausted.
The patient left the hospital with both sensors programmed into passive. The Trending was initiated. Second Follow-up on June, 21th
The following pacemaker information was retrieved: – Sensor trending: MV Blended Sensor Trending. ACC Response Factor= 8; MV Response Factor=3 We can identity a chronotropic incompetent patient looking at the trending graph, and demonstrate the need for the MV Blended Sensor.
The physician checked the ‘accelerometer only’ response with the trending simulation capability. He clearly realized the response difference between ‘accelerometer only’ and the ‘MV Blended sensor’. The MV blended sensor seems to show a better physiologic response than accelerometer, but one key important
factor is the response factor. A bad response factor for MV blended sensor could not be physiologic. So, how can
the physician choose the appropriate response factor for every patient?
The AutoLifestyle™ functionality was explained to the physician
- how it works and how the response factors of the sensors are adjusted
automatically. AutoLifestyle™ was activated.
Third Follow-up on August, 16th (Two months later)
– Activity log:Patient showed higher levels of exercise intensity and daily activity percentage than two months earlier (June, 21).
• Percent of day active 0 Exercise intensity – AutoLifestyle™ report:It showed how response factors have been adjusted in time.
AutoLifestyle™ Settings for Long Term VM – Sensor trending (AutoLifestyle™: ON): Summary:
Comparing this August 16th sensor trending with the previous one (June, 21th), and selecting similar daytime, we can see a more appropriate rate response with AutoLifestyle™.
We asked the patient: ‘How have you felt during this last month?’- and the patient
answered ‘Fine, but when I sleep I have a pain in my back, that could be the pace-
maker…’
So, with the new programming, she just forgot if she is able or not to perform her
daily activities. MV has definitely improved her quality of life.
This case report reflects the opinion of its respective owner.
References:
1 Chronotropic competence is defined by: Wilkoff BL, Corey J, Blackburn G. A mathematical model of cardiac chronotropic response to exercise. J Electrophysio.
1989;3(3):176–180. Refer to Physician’s System Guide for more information on adaptive-rate therapy. Additional clinical performance was assessed using INSIGNIA Defining tomorrow, today.™
Ultra clinical data with the AutoLifestyle feature programmed On. Data on file. N.B. Results from case studies are not predictive of results in other cases. Results in other cases may vary. www.bostonscientific-international.com
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Source: http://www.chronotropic-incompetence.eu/static/files/L05_BG01712_Case_Study_9_Spain.pdf