EP Lab Digest - October 2007 - (Page 30)

30 NEWS OCTOBER 2007 Treating Depression May Improve Recovery of Heart Rate Variability Following Coronary Syndromes H Continued from page 1 eart rate variability refers to the degree to which the heart rate changes from beat to beat in response to normal impulses.“Low heart rate variability predicts death after myocardial infarction,” the authors write as background information in the article, which appeared in the September issue of Archives of General Psychiatry, one of the JAMA/Archives journals.“It is reduced in depressed compared with non-depressed patients after myocardial infarction and has been proposed to be a mediator of the increased mortality associated with depression.” In non-depressed patients who have an acute coronary episode, heart rate variability drops and then recovers substantially but not completely during the next few months. Alexander H. Glassman, MD, of the Columbia University College of Physicians and Surgeons and the New York State Psychiatric Institute, New York, and colleagues measured heart rate variability in 290 depressed patients an average of three weeks after they were hospitalized for acute coronary syndrome, a term encompassing heart events such as heart attack. The patients were then randomly assigned to take either the antidepressant sertraline or placebo for 24 weeks. After 16 weeks, 258 patients returned for a second heart rate variability reading.The severity of each participants’ depression and their clinical response to depression treatment also were measured on previously established scales. At the beginning of the study, previous episodes of depression were associated with lower heart rate variability. At the 16-week follow-up visit, the depressed patients had recovered their heart rate variability more slowly than expected and some even experienced a decrease. Patients who took sertraline had a 9 percent increase in heart rate variability and patients who took placebo had a 10 percent decrease, compared with the 28 to 33 percent increase in recovery of heart rate variability observed in previous studies of non-depressed patients. “Both sertraline treatment and symptomatic recovery from depression were associated with increased heart rate variability compared with placebo-treated and nonrecovered post–acute coronary syndrome control groups, respectively, but this results primarily from decreased heart rate variability in the comparison groups,” the authors write. The mechanisms behind the relationship between heart rate variability, depression and cardiac death remain unclear, the authors note.“What is clear is that depression is associated with biological changes involving increased heart rate, inflammatory response, plasma norepinephrine, platelet reactivity, decreased heart rate variability and now absent post–acute coronary syndrome heart rate variability recovery, all of which is associated with life-threatening consequences. Understanding why these characteristics so strongly associate with depression is crucial to understanding the nature of depression itself,” they conclude. “From a clinician’s point of view, patients with depression after myocardial infarction, especially those with prior episodes, should be both carefully watched and aggressively treated, because they are at an elevated cardiac risk and less likely to get better spontaneously.” This study was supported by a NARSAD Distinguished Investigator Award, the Suzanne C. Murphy Foundation, the Thomas and Caroline Royster Research Fund and Pfizer. SOURCE: Arch Gen Psychiatry 2007;64(9):10251031. St. Jude Medical Announces FDA Approval of Company’s Radiofrequency Wireless ICD and CRT-D Heart Failure Devices t. Jude Medical, Inc. announced FDA approval of its first radiofrequency (RF) wireless devices to treat patients with heart failure and with potentially lethal heart arrhythmias.The Promote™ RF CRT-D (cardiac resynchronization therapy defibrillator) and Current™ RF ICD (implantable cardioverter defibrillator) feature RF telemetry for wandless communication with programmers used by physicians to interrogate and program devices. RF telemetry enables secure, remote communication between the implanted device and the programmers in a clinician’s office or hospital. Wireless communication occurs while the device is being implanted and when patients see physicians for follow-up visits, allowing for efficient, more convenient care and device management. Previously available in Europe, FDA approval brings this advanced technology to U.S. patients as well. The devices use a dedicated range of frequencies designated for medical devices called the MICS (Medical Implant Communications Service) frequency band, which helps to prevent interference from other electronic signals.The MICS technology also includes the capability to choose between 10 channels in order to optimize the telemetry link and avoid interference. The Promote RF CRT-D and Current RF ICD are built on St. Jude Medical’s next generation “Unity” device platform.This consolidated electronics platform will enable St. S Jude Medical to more quickly introduce devices with new features and diagnostics,as they become available, because the basic platform for all of the devices is the same. In addition, the consolidated platform’s expanded capabilities can support more advanced algorithms and features for better patient management. Furthermore, programming during device follow-up will be streamlined, as all software interfaces for new St. Jude Medical pacemakers, ICDs and CRT devices will be the same. The Promote RF CRT-D allows physicians to electronically reconfigure left ventricular (LV) leads to help optimize the pacing performance of the device without the need to physically reposition the lead. In addition, the devices feature the VIP® (Ventricular Intrinsic Preference) algorithm that is designed to allow the patient’s own heart rhythm to prevail when possible.VIP technology actively monitors the heart on a beat-by-beat basis to provide pacing only when needed, which has been shown to be better for patients’ overall heart health. Both devices also feature new patient management tools, such as enhanced patient exercise monitoring that gives the physician information about patient activity levels. Improved lead monitoring capabilities – including painless daily checks of all pacing and shock configurations – provide added patient safety. The Promote RF CRT-D and Current RF ICD devices are scheduled to be launched at the American Heart Association Scientific Session 2007, Nov. 4–7.

Table of Contents Feed for the Digital Edition of EP Lab Digest - October 2007

Finally! The New Registered Cardiac Electrophysiology Specialist (RCES) Credential: Interview with Christopher M. Nelson, RN, RCIS, FSICP ECG 101: Closing the Gap Phenomenon Contents Letter from the Editor ICD Patient Support Group: St. Peter’s Hospital Spotlight Interview: Community Healthcare System Use of Magnetic Catheter Navigation for Ablation of Focal Tachycardias Echocardiography: The Preeminent Front Line Screening and Diagnostic Tool for Cardiovascular Imaging and Physiological Assessment First Annual EP Lab Digest Salary Survey: Last Chance! Clinical Trial Update: 2007 Email Discussion Group Adopting and Implementing the AF Ablation Consensus Statement Electrophysiology in the West Summit Events Calendar The Sustained Treatment of Paroxysmal Atrial Fibrillation (STOP AF) Clinical Trial: Interview with Kevin Wheelan, MD Industry News and Products

EP Lab Digest - October 2007

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