Closed Loop Stimulation
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Closed Loop Stimulation - 1

12359 Berlin -Germany © BIOTRONIK SE & Co. KG Tel +49 (0) 30 68905-0 All rights reserved. Specifications Fax +49 (0) 30 6852804 are subject to modification, sa les@biotronik.com revision and improvement. www.biotronik.com

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Drug response Haemodynamic benefits

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Introduction For patients with most effective contractility, and similar to expected pathophysiologic response of the circulatory system at sucha time. the physiologic restoration of closed-loop chronotropic control. physiological conditions c metabolic requirements. iac output is adjusted by the : adjustment is performed \ restoration of physiological rate response in a range of environments including physical . . , . „ the use of colour word conflict tasks. Intracardiac impedance was measured via the tip of the RV stimulation electrode and reflected changes in blood/tissue concentrations...

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Author J.C.J. Res etAl. Summary Physiological heart rate adaptation is achieved by a new concept monitoring the myocardial contractile state. Since a cardiac parameter is used for evaluating the circulatory demand of the organism, it works independently from the type of load. Furthermore, the rate adaptive principle works with standard pacing leads and does not need any additional sensor. The rate adaptive performance was clinically evaluated for various exercise types. 176 patients (40% female, age 64 ± 14 years) received an Inos DR or lnoS2 DR (BIOTRONIK) dual chamber rate adaptive...

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Author K. Malinowski Introduction In recent years a multitude of rate adaptive sensor signals have been developed to adapt the pacing rate to the physical load of the patient. In contrast to those systems the closed loop stimulation (CLS] represents a new concept, which regards the pacemaker as part of the cardio-circulatory system. The pacemaker converts the body's sympathetic activity into a more appropriate heart rate. The results showed that none of the studied sensor-controlled systems was able to determine an adeguate pacing rate under all of the various load states. The dual sensor...

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Author Zecchi etal. Introduction The goal of this clinical study is to evaluate the improvements in hemodynamic profile and patients quality of life (QoL], when a previously implanted DDDR pacemaker is selectively replaced with a CLS pacemaker, the rate modulation algorithm based on the principle of Closed Loop Stimulation. Methods In seven (7] patients, aged between 56-87years, all with chronotropic incompetence and advanced AV block, a DDDR pacemaker was replaced with a CLS device. One week before and one month after the pacemaker replacement, patients underwent an ambulatory test...

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Author Zecchi etal. Conclusions In all cases CLS showed better rate control and hemodynamic response than conventional rate responsive pacing. Preliminary results show that CLS pacing preserves intrinsic circulatory regulation and integrates the pacemaker in the natural control system, enabling the heart rate to be managed by the Autonomous Nervous System and not byan artificial pacing algorithm. Introduction The recently introduced concept of Closed Loop Stimulation (CLS) represents a completely new approach, not only in the restoration of appropriate heart rates, but also in terms of...

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A late and paradoxical response to mtro-glycerine was observed in groups I and II, and a similar response to phenylephrine was observed in group I. During physiologic manoeuvres, significantly greater variations in heart rate were observed during DDD-CLS than during DDDpacing. Conclusions Sympathetic sensor-driven pacing provides physiological modulations of the heart rate in patients with atrioventricular block and chronotropic incompetence, comparable to that of patients with healthy sinus nodes. Author N. Vijayetal. Summary The goal of this prospective, multicenter, clinical study was to...

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Author Griesbach L. etal. Introduction In conventional, open-loop rate adaptive pacing systems, the physician tailors pacemaker response by carefully programming several rate responsive parameters for each individual. The Inos pacemaker family (Biotronik, Berlin, Germany) uses contraction dynamics to regulate the pacing rate according to the Closed-Loop Stimulation (CLS) principle. These devices are incorporated into the natural cardiovascular control loop, allowing it to guide the pacing rate, cardiac output, and blood pressure toward optimal values. Internal rate responsive parameters...

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In their present technical form, CLS systems require ventricular pacing in all heart cycles to ensure stable morphology of the measured intracardiac signal. Dynamic AV delay should be programmed in the way to slightly overdrive spontaneous AV conduction during rest and exercise. Nonpaced ventricular beats are not taken into account for the pacing rate calculation and can cause a gradual decrease of the pacing rate toward the basic rate until ventricular pacing is reestablished. The atrium maybe paced, sensed, or both. Results Pooled 24-hour heart rate trends are shown in Figure 2. The mean...

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Author L. Griesbach etal. Introduction This study presents the results from the Rate Behaviour of the Pacing System lnos2 CLS during Daily Life (RAPID) study conducted at 16 European clinics with the aim to evaluate the appropriateness of CLS rate profiles during daily activities and the longterm stability ofCLS. Methods 72 patients (40.3%female, age 71.6 ±9.1 years) with sinus node disease were enrolled in the study. 50 patients had sinus node disease in the absence of AV block and 22 patients had binodal disease. lnos2 DR, lnos2 CLS and lnos2+ CLS pacemakers were implanted together with...

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12 An Impedance Sensor (CLS) is Superior to an Accelerometer for Chronotropically Incompetent Patients with Sinus Node Dysfunction: Results of a Pilot Study with a Dual Sensor Pacemaker Author B.B. Pavn etal. Introduction Patients with chronotropic incompetence (Cl) depend on pacemakers for rate response. Many sensors, however, do not provide an adequate heart rate (HR) response. Closed Loop Stimulation (CLS) is an impedance sensor, which monitors local right ventricle myocardial- blood pool impedance as a surrogate for cardiac contractility. CLS establishes a resting or baseline impedance...

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