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Pulse amplitude adjustment provides immediate pacemaker longevity gain

Zlatanovic N ...

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Carotid intima media thickness reduction on statin therapy

Case report

Nenad Zlatanovikj MD.MSC.

Abstract

OBJECTIVE:

Adjusting pacemaker pulse amplitude influences the longevity of the pacemaker. Our aim was to establish the initial longevity gain.

METHODS:

Forty randomly selected patients with implanted pacemakers were analyzed. Mean age was 65.58+/-13.7 years. All pacemakers were working on factory settings of pulse amplitude 3.5 V and pulse width of 0.4 ms for average of 3 years before the adjustment. Initial mean longevity was projected to 68.61+/-18.86 months, mean battery voltage 2.78 V, and mean battery current 14.21+/-2.61 microA.

RESULTS:

Pulse amplitude threshold test was performed and average value of 0.632+/-0.22 V was obtained. Pulse amplitude was programmed to 2.5 V and pulse width was left unchanged. New readings of battery data were obtained. Battery voltage did not show immediate changes, and battery current decreased to 11.53+/-1.98 microA. New average longevity was projected to 81.03+/-19.82 months, which presents a 12.42 months of initial longevity gain with statistical significance at 95% confidence interval (p=0.003). Positive correlation was found between the new pulse amplitude and new values of battery current (p<0.01).

CONCLUSION:

Pulse amplitude decrease of only 1 V provides significant initial longevity gain of more than a year. If found correlations would have any impact on further longevity gains over longer period of time is yet to be established...

Carotid intima media thickness CIMT) is an important marker of atherosclerosis progression and extent even in absence of formed atherosclerotic plaques, occlusive or non-occlusive.

• Though still controversial some studies have suggested that optimized antihyperlipemic therapy might significantly reduce atherosclerotic plaques.
• A 58 year old patient was referred to a preventive general cardiology ultrasound exam. He denies any subjective cardiac difficulties. He is a heavy smoker, with moderately increased lipid’s profile, normotensive with no significant family history for cardiac disease. His echocardiogram indicates early stages of diastolic dysfunction, otherwise with normal function. 
• His 10 years CVD risk score according to Heart Score chart is 8% , high risk and well above the risk for his age 
• When first referred he doesn’t receive any medical treatment.
• His first carotid ultrasound revealed marked increase of carotid intima media(CIMT) thickness bilaterally at the level of carotis communis. 
• He was placed on Atorvastatin of 40mg and Aspirin of 100mg qid
• Three years later at the age of 61, he comes for a general check up. He is still normotensive, still smoker and still symptom free. The target LDL-C has not been completely achieved (~3.0mmol/l) although he claimed he was taking his medication regularly. His echocardiogram is unchanged...

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