Abstracts
Abstracts Najaarcongres Nederlandse Werkgroep Hartstimulatie Alkmaar, 22 november2002 Automatic data exchange between pacemaker programmers and GRIT-SPRN WA. Dijk, CAM Hooijschuur and W. van der Velde Thyoraxcenter University Hospital Groningen The Central Pacemaker Registry (CPPR) in the Netherlands (founded in 1977) collects information of pacemaker- and ICD patients from all 110 Dutch pacemaker clinics. It contains data of over 100.000 patients. In order to reach maximal integrity on the collected information delivered by the clinics, one national Pacemaker and ICD information system for all cinics was developed. All relevant locally generated data is transmitted (encrypted) to the central registry through e-mail. The most time consuming administrative task is the process of copying the information from the paper output ofthe pacemaker programmers into the information system by hand. The different paper layout used by the different manufacturers is an additional complicating factor. We therefor started a project to connect the programmers directly to the information system using communication standards. As the amount oftransmitted (alphanumeric) information is rather small no speed considerations were taken into account, resulting in a serial line (RS232) based easy switchable cabling structure. The widely used Health Level 7 (HL-7) communication protocol, enabling strict definition ofthe data description, is used as the exchange language. A pilot project is started in corporation with on of the pacemaker companies in which the communication based on HL-7 between 2 PC's will be developed. The digital information from the programmer is fed into one PC and converted into HL-7. This HL-7 message is then transmitted to the information system and made visible for supervision. The PC, representing the programmer, will be replaced by a real programmer at a later stage when the programmer is able to "speak" HL-7. The implementation process will be monitored by a working group consisting out of members from the Dutch working group on cardiac pacing. Is the rate responsive fictor as determined by the Age & Lifestyle algorithm from Minute Ventilation (MV) sensor less appropriate than the combination of MV and accelerometer ? W.G. de Voogt, PA. Dekker, R.J. Wolting *M. Berkhof, St. Lucas-Andreas Hospital,Amsterdam, Netherlands, *Stjude Medica4
(MV) rate response from Pacesetter Tempo. The ratio ofthe initial to the second slope ofthe modified MV rate response was measured by a sensor based histogram and determined by the physicians programming "Age" and one ofthe three "Lifestyle" parameters: Sedentary, Average, Athletic. Using these programmed parameters, the modified MV rate responsive algorithm then determined the slope ratio and the location ofthe "breakpoint" between the two slopes. The Rate Response Factor (RRF) determines by software how much the pacing rate changes in response to a given change in minute ventilation. Objecte The focus of this pilot studywith 12 Tempo_ pacemakers was to demonstrate that with age predicted maximum heart rate programming associated with the modified minute ventilation rate responsive algorithm and lifestyle feature, an overaggressive rate response is not observed during exercise as RRF is programmed by standard settings. This was compared with a stapped-on Trilogy DR+ accelerometer driven rate response pacemaker. Method: Implant 12 Tempo5 pacemakers (indication AV block, normal sinus node) and program age and lifestyle as suggested by the Tempo5. Perform a exercise test (CAEP) protocol and measure the heart rate 1/at rest; 2/ after 2 minutes and 3/ at the end of the test. Measure and compare the atrial rate and sensor rate as determined by PVARP. Results: (n=12; 9male, 1 female; mean Age 68,4*4 years; Lifestyle: 9 Average, 1 Athletic, 2 Sedentary)
Rate (bpm) Atrial rate: MV sensor rate: ACT sensor rate:
At ret
2 mnd exercise
61.2±1.03 61.5±2.32
91.1±2.60 88.5±2.63 98.9±5.10
60.0±0.01
END exercse 128.6±1.67 127.2±1.78 100.0±1.87
Condusion: 1-The rate responsive factor as determined by the Age and Lifestyle algorithm is appropriate and no aggressve over pacing was seen. RRF might be increased by a value of "2" to more closely mimic the sinus node response, without over pacing the patient's intninsic rate. 2- Accelerometer rate adaptation showed no incremental benefit in adaptation to sinus node exercise response.
Background. We studied the patient age along with lifestyle parameters that provide the physician flexibility to firther define the minute volume
Netherlands Heart Journal, Volume 11, Number 5, May 2003
241
Abstracts Najaarcongres Nederlandse Werkgroep Hartstimulatie Alkmaar, 22 november2002 Automatic data exchange between pacemaker programmers and GRIT-SPRN WA. Dijk, CAM Hooijschuur and W. van der Velde Thyoraxcenter University Hospital Groningen The Central Pacemaker Registry (CPPR) in the Netherlands (founded in 1977) collects information of pacemaker- and ICD patients from all 110 Dutch pacemaker clinics. It contains data of over 100.000 patients. In order to reach maximal integrity on the collected information delivered by the clinics, one national Pacemaker and ICD information system for all cinics was developed. All relevant locally generated data is transmitted (encrypted) to the central registry through e-mail. The most time consuming administrative task is the process of copying the information from the paper output ofthe pacemaker programmers into the information system by hand. The different paper layout used by the different manufacturers is an additional complicating factor. We therefor started a project to connect the programmers directly to the information system using communication standards. As the amount oftransmitted (alphanumeric) information is rather small no speed considerations were taken into account, resulting in a serial line (RS232) based easy switchable cabling structure. The widely used Health Level 7 (HL-7) communication protocol, enabling strict definition ofthe data description, is used as the exchange language. A pilot project is started in corporation with on of the pacemaker companies in which the communication based on HL-7 between 2 PC's will be developed. The digital information from the programmer is fed into one PC and converted into HL-7. This HL-7 message is then transmitted to the information system and made visible for supervision. The PC, representing the programmer, will be replaced by a real programmer at a later stage when the programmer is able to "speak" HL-7. The implementation process will be monitored by a working group consisting out of members from the Dutch working group on cardiac pacing. Is the rate responsive fictor as determined by the Age & Lifestyle algorithm from Minute Ventilation (MV) sensor less appropriate than the combination of MV and accelerometer ? W.G. de Voogt, PA. Dekker, R.J. Wolting *M. Berkhof, St. Lucas-Andreas Hospital,Amsterdam, Netherlands, *Stjude Medica4
(MV) rate response from Pacesetter Tempo. The ratio ofthe initial to the second slope ofthe modified MV rate response was measured by a sensor based histogram and determined by the physicians programming "Age" and one ofthe three "Lifestyle" parameters: Sedentary, Average, Athletic. Using these programmed parameters, the modified MV rate responsive algorithm then determined the slope ratio and the location ofthe "breakpoint" between the two slopes. The Rate Response Factor (RRF) determines by software how much the pacing rate changes in response to a given change in minute ventilation. Objecte The focus of this pilot studywith 12 Tempo_ pacemakers was to demonstrate that with age predicted maximum heart rate programming associated with the modified minute ventilation rate responsive algorithm and lifestyle feature, an overaggressive rate response is not observed during exercise as RRF is programmed by standard settings. This was compared with a stapped-on Trilogy DR+ accelerometer driven rate response pacemaker. Method: Implant 12 Tempo5 pacemakers (indication AV block, normal sinus node) and program age and lifestyle as suggested by the Tempo5. Perform a exercise test (CAEP) protocol and measure the heart rate 1/at rest; 2/ after 2 minutes and 3/ at the end of the test. Measure and compare the atrial rate and sensor rate as determined by PVARP. Results: (n=12; 9male, 1 female; mean Age 68,4*4 years; Lifestyle: 9 Average, 1 Athletic, 2 Sedentary)
Rate (bpm) Atrial rate: MV sensor rate: ACT sensor rate:
At ret
2 mnd exercise
61.2±1.03 61.5±2.32
91.1±2.60 88.5±2.63 98.9±5.10
60.0±0.01
END exercse 128.6±1.67 127.2±1.78 100.0±1.87
Condusion: 1-The rate responsive factor as determined by the Age and Lifestyle algorithm is appropriate and no aggressve over pacing was seen. RRF might be increased by a value of "2" to more closely mimic the sinus node response, without over pacing the patient's intninsic rate. 2- Accelerometer rate adaptation showed no incremental benefit in adaptation to sinus node exercise response.
Background. We studied the patient age along with lifestyle parameters that provide the physician flexibility to firther define the minute volume
Netherlands Heart Journal, Volume 11, Number 5, May 2003
241
