CRT51: AGGRAVATION OF THE CLINICAL STATUS OF CRT-P PATIENT DOCUMENTED BY PACEMAKER MEMORIES: A CASE REPORT

Rate-responsive pacemakers (PM) provide meaningful information to permanently follow-up the physical status of implanted patients. We report the case of a CHF patient fitted with a CRT-P device. ELA Medical PMs feature accelerometer and minute ventilation sensors. Cross-check between both sensors allows the calculation of the activity duration (Ad). The accelerometer reflects the mean intensity of physical activity (Ai), and mean minute ventilation (MV) is calculated at rest (MVr) and during activity phases (MVa). A 52 y. old male (LVEF 16%, NYHA class III) received a Talent 3 MSP PM on Oct 2003. The patient had an out-hospital visit due to CHF aggravation on the 01/01/04, then was hospitalized for HF decompensation. CRT appeared to be ineffective, and was deactivated with an increase of drug therapy. Analysis of PM data: ![Figure][1] Period 1: stable phase. Ad and Ai increase slowly, up to a stable level. MVa/Ai increase independently from Ai level, suggesting that this indicator is independent from patient's daily-life activity. Period 2: hyperactivity. the patient develops unusual high levels of activity (Ai), with an important increase of MVa/Ai. In the same time, MVr, which was stable increases dramatically, which suggests a degradation of his pulmonary function even at rest. Period 3: Drop by 50% in Ai and MVr decrease suggest an impossible sustained exercise. Period 4: MVa/Ai still increases, and MVr increases again. MV vary now independently from Ai. The patient is hospitalized for HF. Data provided by the PM may help in predicting the degradation of the cardio-pulmonary status of CRT patients, allowing a better management of HF therapy. [1]: pending:yes