Aim of the Study: Current Pacemakers (PM) measure the pacing lead impedance (imp) dunng stimulation (slim).This requires the patient (pat) to be paced, otherwise special test pulses are necessary.This makes contJnuos imp monitoring difficult.In addition, some pats may be irritated by test pulses.The Medtrenic.Kappa 400 PM allows in addition continuos imp monitodng by subthreshold (sbd) test pulses, Methods and Materials: Dudng the study (VIM = Ventncular Impedance Measurement) Imp values were measured simultaneously using both techniques in each pat at hospital discharge, 3-months follow-up and 9-months follow-up in unipolar and bipolar configuration.The PM used was Modlronic.Kappa 400, lead types analyzed were MOT 5068 (31 atrial leads), MDT 5034 (20 venldcular leads) and STJ 1452T (13 venthcular leads).Two different types of venthcular leads were implanted in randomized order in one inslitulion (University of Innsbruck).Results: The total study population consisted of 48 pats (29 male, 19 female) with a mean age of 69.3 year +/-13,8 years, Companng slxI imp values with imp values during pacing shows that sed values were lower in most cases.The table below shows the average percenlsge the sed measurements are lower than measurements under slim.Lead Model, Pol.Hospital Discharge 3-Months-Follow-Up 9.Months-Follow-Up Mean value / SD / n Mean value / SD / n Mean value / SD / n MDT 5068 unip.-26% / 219% / n=3t -34% / ±6,4% / n=27 -31% / 28,8% / n= 9 bip.-39%1±14%1n=31 -44%1±5% /n=28 -43%/±6,3%/n=19 MDT5034unip.-t5%/±16%/n=20 -11%/±6,1%/n=18 -10%/±-6,7%/n=15

Aim: The aim of the paper was to analyse the type and the degree of progression of arrhythmias, that make up the base for selecting patients (pts) with the Emery-Dreifuss syndrome of muscular dystrophy to have a permanent cardiac pacing.Material and methodology: Between 1976 and 2000, 8 men with the Emery-Dreifuss syndrome of muscular dystrophy were selected to have a continuous artificial pacing of the head.At the time of implantation the mean age of the pts was 26,5 years (21-34 years).The assessment of the arrhythmias character have been made with the use of ECG recording and 24-hour Holter monitoring.In 4 pts who initially had a sinus rhythm was carried out an transesophageal stimulation of the left atrium and an electrophysiologic investigation.In 4 pts was diagnosed an established atrial fibrillation, whereas the Holter recording marked a noticeable tendency towards a significant deceleration of the ventdcular rhythm without triggering off haemodynamic disturbances.One pt did not show any clinical symptoms although he had periodic rhythms of 19/min.The other 4 pts had paroxysmal arrhythmias.During the above-mentioned diagnostics and when trying to fix the electrode for cardiac pacing in the atrium was observed a noticeable readiness to trigger off supraventdcular dysrhythmias that were difficult to control.There was one case of a delay in the activation of the right atrium of more than 100 ms.All pts had signs of conduction disturbances at different levels of the impulse-originating/conduction system of the head.Conclusions: Because of the high risk of sudden death, we recommend permanent pacemaker implantation even in asymptomatic subjects, as soon as bradyarrhythmias, or cardiac conduction abnormality, are detected.

Pentoxifylline (PTX), a xanthine derivative used in the treatment of circulatory insufficiency, has been found to have protective effects in different models of sepsis. We hypothesized that this drug might either increase oxygen delivery (DO2) and/or increase tissue oxygen -extraction to meet oxygen demand in sepsis. We studied the effects of PTX on the oxygen uptake/oxygen delivery (VO2/DO2) relationship and tissue oxygen extraction when blood flow was reduced by Inducing cardiac tamponade in 14 anesthetized, ventilated and paralyzed dogs. Via a left thoractomy, a catheter waa inserted into the pericardial space for saline injection. Each dog was given a 2 mg/kg bolus of E. coli endotoxin and received 20 mlkg.h of normal saline•duririg the study. In 7 dogs, PTX was administered as a 20 mg/kg i.v. bolus, followed by a continuous infusion at 20 mglkg.h. V02 was derived from the expired gases. 002 was calculated by the product of the modüution cardiac index and arterial oxygen content. Oxygen extraction ratio (02ER) was defined as the ratio of V02/002. Dual-line regression was used to determine the critical 002 (DO2crit) in each animal. ANOVA was used for statistical analysis. PTX resulted in significant increases in V02 and DO2. Critical V02 was slightly higher in the PTX-treated than in the control group, but it did not reach statistical significance (6.3 ± 2.4 vs 5.4 ± 1.0 ml/kg.min, NS). D02crit which was 11.3± 4.9 ml/kg.min in the control group, was decreased to 9.6 ± 3.6 mlkg.min in the PTX-treated group (p = 0.05). Critical 02ER significantly increased from 50 ± 20% in the control to 68 ± 19% in the PTX-treated animals (p< 0.05). The V02/D02 dependency slope was steeper in the PTX-treated than in the control group (0.77 ± 0.31 vs 0.46 ± 0.18, p< 0.05). At D02c rit, PTX-treated group had lower venoarterial PCO2 difference (12.9 t. 4.3 vs 18.4 ± 7.4 mmHg, p < 0.05) and arteriovenous pH gradient (0.08 ± 0.02 vs 0.11 ± 0.06 U, p < 0.05) than in the control group. Thus, the addition of PTX and fluid therapy can increase 002 and global oxygen extraction capabilities when cardiac output is progressively reduced in the endotoxemic dog. The exact mechanisms remain to be defined.