E UROPACE Conclusions: Use of a steerable sheath allows safe, reproducible and efficient implantation of stylet-less pacing leads in non-traditional predefined sites. Clinical implications: 1. Steerable sheaths enable implantation of styletless pacing leads 2. Lack of a need for a stylet lumen, allows development of considerably smaller diameter leads with enhanced resilience. I P 376 A N E W ALGORITHM FOR VENTRICULAR CAPTURE DETECTION IN ICDS AUTOMATIC .I. Sperzel’, T. Schwartz’, G. Borianiz, M. Biffiz, A. Koenig3, R. Willems3, Y. Dong4, S. Meyer4. ‘KerckhoffKlinik, Bad Nauheim, Germany, 21Jniversity Hospital, Bologna, Italy, 3Guidant Europe, Diegem, Belgium and “Guidant Corporation, St. Paul, MN, USA I P 377 VENTRICULARARRHYTHMIA INASSESSEMENT PACEMAKER ACTROS MEMORY DATA OF Medical University of Lodz, vs (W) HM P. 9,12+13 9,17+14 0,89 COMPARISON OF T W O CANNULATION VENOGRAPHY STRATEGIES DURING BIVENTRICULARIMPLANTS AND G. De Martim, D. Gabrielli, A. Del10 Russo, G. Pelargonio, G. Fassini, P. Della Bella, L. Messano, T. Chiriaco, P. Zecchi, F. Bellocci. Universitd Cattolica Del Sacro Cuore, Roma, Cenho Cardiologico, Fondazione of Poland VP (%) As (W) AP (%) VEBIZ4h HR mean 90,9+14 90,9+14 0,974 43,08*37,8 43*38 0,819 56,5+38 56,9+38 0,388 453,3+915 192,5+362 0,OS 81,3+2,7 81,4+2,6 0,89 Conclusion: 1. No significant differences between values of As, Ap, Vs, Vp and HR mean 2. Although the number of single VEBs assessedby PH was higher than in HM, the difference was not statistically significant. However, the usefulness of VEBs count evaluation by PH in clinical practice seems to be limited. Monzino Background: Identification of operative strategies associated with reduction of procedural time and complications is a critical objective of research in the field of cardiac resynchronization therapy. Aims of the study: W e designed a study to compare procedural time and complications of coronary sinus (cs) catheterization and venogmphy with two different techniques. Study design: Thirty-four consecutive patients were randomly assigned to a guiding-catheter-alone strategy (gca) or to an electrophysiology-catheter-aided strategy (epa). In the gca strategy cs cannulation was attempted with several commercially available dedicated delivery systems (mp 7300.mp 6717, guidant carp. Or 6216, medtronic inc.), while in the epa strategy an electrophysiology catheter (al, daig carp.) Was advanced inside the delivery system to assist the procedure. Moreover, after cs cannulation, patients were randomly assigned to an occlusive venography technique (ov), with cs occlusion through swan-ganz balloon tipped catheter, or to a direct venogmphy technique (dv), in which contrast dye was injected straight into the delivery system. Results: Successful catheterization of cs was achieved in 15118 patients (84%) of gca group as compared to 15116 patients (94%) of epa group (p=ns.). Time to catheterization of cs was 9.9&5.8 min. In the gca group as compared to 4.4&2.6 min. In the epa group (p=O.O04). Venography was rated accurate in 13116 patients (81%) assigned to dv and in 16116 patients (100%) assigned to ov (p=O.O6, ns). Four cs dissection have been observed, all in the gca group (314 in gca + ov pts vs l/4 in gca + dv pts, pas). The course of cs dissection was uneventful and implant was successfully completed in all cases. Conclusions: Epa is at least as effective as gca cannulation strategy and significantly shortens procedural time. Dv is feasible and effective as ov and shows a non-significant trend towards a. Lower incidence of complications. I P 379 EFFECTS OF INTERATRIAL SEPTUM PACING ON INTERATRIAL CONDUCTION TIMES AND ON SYSTOLIC AND DIASTOLIC VENTRICULAR FUNCTION: AN ECHO-DOPPLER STUDY C. Oneglia, A. Gardini, G. Benedini, C. Rusconi. Dept. Cardiology, The aim of the study was to evaluate the accuracy of an implanted Biotronik Actros D (DDD) pacemaker memory data (HP) in estimation of pacing and sensing episodes and single ventricular extrasystole beats (VEB) Materials and Methods: 32 patients (18 males, 14 females) aged 35.76yrs (av.68 ys), implanted with Biotronik ACTROS D pacemaker were studied. 24 hours Halter ECG (HM) using Oxford Medilog System. with simultaneously restarting pacemaker’s statistics functions (PH): event counter, activity report and ventricular extrasystolic statistic were performed in each patient. Comparison of the following events: atria1 sense (As), atria1 pace (Ap), ventricular sense (Vs), ventricular pace (VP), VEBs and mean heart rate (HR mean) was performed. Results: The results are shown in a Table. T-Student test was used for statistics analyses. PH P 378 Hospital, J.K. Wraniu, M. Chudzik, .I. Zrobek, M. Rosiak, I. Cygankiewicz. Institute Cardiology, I Brescia, S. On& Italy In the present study we assessthe effects of inter&al septum pacing (IASP) on atria1 conduction intervals and on parameters of systolic and diastolic function in patients (pts) with dual-chamber pacing and normal cardiac function. The following parameters were considered in sinus rhythm (SR) and during IASP in AA1 mode at a rate of SO/min. 1) Right and left atria1 conduction intervals (R and L CI) from the beginning of the P wave or pacing spike to the beginning (B) or peak (P) of the A wave on transtricuspidal and trammitral Doppler flow velocities. 2) Differences between the right-to-left CI (RtoLCI). 3) Tricuspidal (T) and mitral (M) peak velocity of E and A waves, deceleration time of E wave (DTE), A wave duration, integral of pulmonary and aortic flow on Doppler examination. 4) Left ventricular ejection fraction on B-dimensional echo. 5) Maximal systolic motion (MSM) of T and M annulus on M-mode echo. Ten pts (7 M, 3 F, mean age 66X&9.4, range 48-74 years) were implanted for bradycardia-tachycardia syndrome. Compared to SR a delayed right atria1 contraction with reversion of normal right-to-left sequence was observed with IASP (RCIB: 79.6&19.8 vs 147.9&37.7 ms, p<O.OOl; LCIB: 93.9&19.7 vs 102.2&16.2 ms, p=NS; RtoLCIB: +14.3&28.4 vs -45.7&32.5 ms, p <O.OOl; RCIP: 145.9&29.8 vs 217&37.9 ms, p<O.OOl; LCIP 165.3&16.4 vs 168X&23 ms, p=NS; RtoLCIP +19.4&27.5 vs -48.2&21 ms, p<O.OOl). No significant differences of echo-Doppler parameters of left diastolic and systolic function were observed with IASP as compared to SR. A decrease in tricuspidal DTE (from 227.9&43.7 to X36.8&58.1 cm/set, p ~0.05) and in the integral of pulmonaryflow(from 0,197&0,03 cm to 0,167&0,02 cm,p<0,05)was observed with IASP. M S M of T (24.2&11.1 vs 21.4&S mm) and M anulus (16.1&6.1 vs 15.6&5.5) did not differ during SR and IASP. In conclusion with IASP we observed 1) a delayed right atria1 activation 2) no echo-Doppler signs of left ventricular dysfunction 3) an impairment of right ventricular function. Europace Supplements, Vol. 4, December 2003 B155 Downloaded from by guest on November 24, 2014 Automatic capture detection may increase patient safety and expand device diagnostics and automaticity. This study evaluated a new capture detection algorithm (CDA) for ICDs using the evoked response (ER) from the right ventricular shocking coil (RVail) to Can sensing vector. The CDA uses combined signal amplitude and timing information to discriminate capture (C), fusion (F), and non-capture (NC) beats. The study was performed during new ICD implant or device replacement. Ventricular step-down threshold testing was conducted with AVD = 60 ms in DDD patients (pts) or intrinsic rate + 10 bpm in VVI pts. Surface ECG and intracardiac electrograms were recorded on a wideband pacing and data acquisition system. The signals were then downloaded to a computer system, and each beat was independently classiiied by visual examination of the surface ECG morphology and by the CDA. CDA performance was evaluated by comparison of the classiiication results. A total of 16 pts were studied with two pts excluded from the data analysis due to improper pacing parameters. For the remaining 14 pts (llMI3F; 64.0&6.9 ys), the device and lead demographics were: 8 DDD/6 VVI; 9 dedicated BP/S integrated BP leads; 11 acute/3 chronic (4.3&0.4 years) leads. A total of 639 beats were analyzed: 593 C beats, 18 F beats, and 28 NC beats. The sensitivity and the specificity for NC detection were both 100%. Correct detection rates for C, NC, and F beats were 99.3%, lOO%, and lOO%, respectively. Four C beats (0.7%) were misclassiiied as F due to temporal shifts in the ER signal. The results indicate that a highly sensitive capture detection algorithm can be implemented using the RVwil to Can electrogram. 2003