Aerobic Capacity in Rate Modulated Pacing

Lemke, Bernd; Dryander, Stefan von; Jäger, D; Machraoui, A.; MacCarter, Dean; Barmeyer, J.

doi:10.1111/j.1540-8159.1992.tb02993.x

Cited by 20 publications

(4 citation statements)

References 7 publications

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“…Regardless of the definition applied, however, published findings have demonstrated for pacemaker patients that they profit from rate‐adaptive pacing, especially in confirmed cases of CI 17–19 …”

Section: Discussionmentioning

confidence: 99%

Chronotropic Incompetence in Patients with an Implantable Cardioverter Defibrillator: Prevalence and Predicting Factors

Melzer

Böhm

Bondke

et al. 2005

Pacing Clinical Electrophis

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Chronotropic incompetence (CI), which has not been systematically examined in the ICD patient population, may have implications for device programming. A total of 123 ICD patients were classified into three groups: single-chamber ICD with sinus rhythm, dual-chamber ICD with sinus rhythm, and single-chamber ICD with permanent atrial fibrillation. Heart rate response, maximum oxygen uptake, and oxygen uptake at the anaerobic threshold were measured during treadmill exercise testing. In addition, clinical variables such as antiarrhythmic drug therapy, underlying heart disease, and left-ventricular (LV) ejection fraction were recorded. Of the patients studied, 38% were chronotropically incompetent (47/123). Significant predictors of CI were as follows: presence of a coronary disease (P = 0.036), prior cardiac surgery (P = 0.037), chronic drug therapy with beta-blockers (P = 0.032), administration of amiodarone (P = 0.025), and a combination of these two forms of treatment (P = 0.01). Spiroergometry revealed reduced exercise capacity (P = 0.041) and lessened VO2max (P = 0.034) among chronotropically incompetent patients. A large percentage of ICD patients demonstrates CI with subsequently reduced physical stress tolerance. In light of the DAVID study, we believe that a closer examination of rate-adaptive modes for ICD patients is warranted under enhanced conditions: (1) optimized AV interval programming; (2) utilization of new algorithms to reduce ventricular pacing in combination with rate-adaptive atrial pacing, with the goal of addressing CI while minimizing ventricular pacing; and (3) an optimized upper heart-rate limit.

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Section: Discussionmentioning

confidence: 99%

Chronotropic Incompetence in Patients with an Implantable Cardioverter Defibrillator: Prevalence and Predicting Factors

Melzer

Böhm

Bondke

et al. 2005

Pacing Clinical Electrophis

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“…Further, the contribution of the atrial kick may change during exercise. Most,13 14 25but not all,26 studies in patients with artificial pacemakers suggest that the increase in ventricular rate during exercise is more important to cardiac output than atrial contraction, and this may be particularly true for patients with systolic left ventricular dysfunction 27. On the other hand, restoration of atrial contraction has also been shown to parallel5 or to precede6 the improvement of peak V˙O 2 after cardioversion; the lower peak heart rate after cardioversion suggests that intact atrial functioning yields a higher stroke volume during exercise, and thus increases exercise capacity.…”

Section: Discussionmentioning

confidence: 99%

Atrial fibrillation is associated with a lower exercise capacity in male chronic heart failure patients

Pardaens¹,

Cleemput

Vanhaecke

et al. 1997

Heart

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Objective-To study the influence of atrial fibrillation on peak oxygen uptake (peak ṼO 2 ) in chronic heart failure. An unfavourable eVect of atrial fibrillation has been shown in several patient populations, but the results have not been consistent in chronic heart failure. Methods-Data were analysed from male heart transplant candidates who were able to perform graded bicycle ergometry until exhaustion with respiratory gas analysis and measurement of heart rate. Patients in atrial fibrillation (n = 18) were compared with patients in sinus rhythm (n = 93). Results-Age, weight, height, and aetiology of chronic heart failure did not diVer significantly between the two groups. Cardiac catheterisation at supine rest showed that heart rate was comparable, but that stroke volume and cardiac output were lower (p < 0.05) in atrial fibrillation. Systolic and diastolic left ventricular function, assessed by radionuclide angiography at rest, were not significantly diVerent. Peak ṼO 2 (mean (SD): 13.8 (3.6) v 17.1 (5.6) ml/kg/min; p < 0.01) and peak work load (78 (27) v 98 (36) W; p < 0.05) were lower in the patients with atrial fibrillation, though respiratory gas exchange ratio and Borg score were similar in the two groups. Patients with atrial fibrillation had a higher heart rate sitting at rest before exercise (93 (16) v 84 (16) beats/min) and at peak eVort (156 (23) v 140 (25) beats/min) (p < 0.05). Conclusions-Atrial fibrillation is associated with a 20% lower peak ṼO 2 in patients with chronic heart failure, suggesting that preserved atrial contraction or a regular rhythm, or both, are critical to maintain cardiac output and exercise performance.

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“…Those patients, however, who are young or more physically active, as well as those with hemodynamic compromise, may require optimization of rate-response settings, including adjustment of the atrioventricular delay, by use of more accurate and reproducible methods such as CPX. [175][176][177][178] In this regard, investigators have reported the use of several metabolic parameters derived from CPX as clinical end points in the assessment of patients with rate-responsive pacemakers. Adjustments of the atrioventricular delay and rate-response settings have been reported to increase peak V O 2 , VT, and O 2 pulse.…”

Section: Evaluation Of Cardiac Pacemaker Functionmentioning

confidence: 99%

Clinician’s Guide to Cardiopulmonary Exercise Testing in Adults

Balady¹,

Arena

Sietsema³

et al. 2010

Circulation

1,601

925

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E xercise testing remains a remarkably durable and versatile tool that provides valuable diagnostic and prognostic information regarding patients with cardiovascular and pulmonary disease. Exercise testing has been available for more than a half century and, like many other cardiovascular procedures, has evolved in its technology and scope. When combined with exercise testing, adjunctive imaging modalities offer greater diagnostic accuracy, additional information regarding cardiac structure and function, and additional prognostic information. Similarly, the addition of ventilatory gas exchange measurements during exercise testing provides a wide array of unique and clinically useful incremental information that heretofore has been poorly understood and underutilized by the practicing clinician. The reasons for this are many and include the requirement for additional equipment (cardiopulmonary exercise testing [CPX] systems), personnel who are proficient in the administration and interpretation of these tests, limited or absence of training of cardiovascular specialists and limited training by pulmonary specialists in this technique, and the lack of understanding of the value of CPX by practicing clinicians.Modern CPX systems allow for the analysis of gas exchange at rest, during exercise, and during recovery and yield breath-by-breath measures of oxygen uptake (V O 2 ), carbon dioxide output (V CO 2 ), and ventilation (V E). These advanced computerized systems provide both simple and complex analyses of these data that are easy to retrieve and store, which makes CPX available for widespread use. These data can be readily integrated with standard variables measured during exercise testing, including heart rate, blood pressure, work rate, electrocardiography findings, and symptoms, to provide a comprehensive assessment of exercise tolerance and exercise responses. CPX can even be performed with adjunctive imaging modalities for additional diagnostic assessment. Hence, CPX offers the clinician the ability to obtain a wealth of information beyond standard exercise electrocardiography testing that when appropriately applied and interpreted can assist in the management of complex cardiovascular and pulmonary disease.

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Aerobic Capacity in Rate Modulated Pacing

Cited by 20 publications

References 7 publications

Chronotropic Incompetence in Patients with an Implantable Cardioverter Defibrillator: Prevalence and Predicting Factors

Chronotropic Incompetence in Patients with an Implantable Cardioverter Defibrillator: Prevalence and Predicting Factors

Atrial fibrillation is associated with a lower exercise capacity in male chronic heart failure patients

Clinician’s Guide to Cardiopulmonary Exercise Testing in Adults

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