Indications for Implanting Rate-Adaptive Cardiac Pacemakers

Alt, Eckhard; Matula, Markus; Heinz, Michael

doi:10.1007/978-3-642-76649-7_6

Rate Adaptive Cardiac Pacing 1993

DOI: 10.1007/978-3-642-76649-7_6

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Indications for Implanting Rate-Adaptive Cardiac Pacemakers

Eckhard Alt

Markus Matula

Michael Heinz

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Cited by 3 publications

(2 citation statements)

References 28 publications

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IntroductionRate adaptive pacing is aimed at providing appropriate pacing support throughout a full range of patient activities, including activities of daily living (ADL) and exertional tasks. 1 The performance and benefits of rate adaptive pacing have been well described in adult patients. However, the unique physiology and and activity patterns of children create challenges when provid-ing pacing therapy in pediatric patients, especially in those participating in demanding physical activities requiring a high cardiac output.

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confidence: 99%

Can Current Minute Ventilation Rate Adaptive Pacemakers Provide Appropriate Chronotropic Response in Pediatric Patients?

Cabrera

Portzline

Aach

et al. 2002

Pacing Clinical Electrophis

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Since children have different activity patterns and exercise responses, uncertainty exists as to whether minute ventilation (MV) sensors designed for adults provide adequate chronotropic response in pediatrics. In particular, high respiratory rates (RR > 48 breaths/min), which are characteristic of the ventilatory response to exercise in children, cannot be sensed by MV rate responsive pacemakers. The purpose of this study was to evaluate the MV sensor rate response of the Medtronic Kappa 400 using exercise data from healthy children in a computer simulation of its rate response algorithm. Thirty-eight healthy children, ages 6-14, underwent a treadmill maximal exercise test. Subjects were divided based on body surface area (BSA) and MV rate response parameters were selected. Respiratory rates and tidal volumes were entered into the Kappa 400 rate response algorithm to calculate sensor-driven rates. Intrinsic heart rate (HR), oxygen uptake, and sensor-driven rates were normalized to HR reserve (HRR), metabolic reserve (MR), and sensor-driven reserve to compare across groups. Linear regression analysis among sensor-driven rate reserve, HRR, and MR was performed as described by Wilkoff. The mean slopes (+/- SD) of the relationships between the sensor-driven rate reserve and HRR were 1.06 +/- 0.34, 1.07 +/- 0.28, and 1.01 +/- 0.19 for children with BSA < 1.10 m2, 1.10 < BSA < 1.40 m2, and BSA > 1.40 m2, respectively. High correlations were found between sensor-drive rates and HR responses and between sensor-drive rates and MV throughout exercise. No significant differences were noted between sensor-drive rates and HR using the Wilkoff model. From this study the authors conclude that: (1) MV is a good physiological parameter to control heart rate and (2) simulated sensor-driven rates closely match intrinsic HRs during exercise in healthy children, which supports the appropriateness of clinical validation in pediatric pacemaker patients.

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“…

…”

mentioning

confidence: 99%

Can Current Minute Ventilation Rate Adaptive Pacemakers Provide Appropriate Chronotropic Response in Pediatric Patients?

Cabrera

Portzline

Aach

et al. 2002

Pacing Clinical Electrophis

View full text Add to dashboard Cite

show abstract

“…performance and aerobic capacity. 4 Rate-adaptive pacing stimulation attempts to normalize HR relative to Vo2.…”

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confidence: 99%

Intrinsic Heart Rate Response as a Predictor of Rate-Adaptive Pacing Benefit

Alt

Schlegl

Matula

1995

Chest

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Activity Controlled Cardiac Pacemakers During Stairwalking: A Comparison of Accelerometer with Vibration Guided Devices and with Sinus Rate

Matula

Schlegl

Alt

1996

Pacing Clinical Electrophis

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Activity controlled pacemakers are the most widely used rate adaptive systems. We studied second-generation activity controlled systems (accelerometer) in 21 patients with such an accelerometer controlled system implanted during walking level and stairs. We compared them to the rate of vibration controlled, first-generation activity pacemakers and to the sinus rate of a healthy control group. A metronome directed the speed during walking and climbing stairs at 92, 108, and 120 steps/min. At 92 steps/min, the new accelerometer controlled systems showed a significant (P < or = 0.001) pacing rate increase from 107 +/- 8 beats/min during walking level to 124 +/- 8 beats/min during climbing stairs, and a significant decrease to 105 +/- 12 beats/min during walking downstairs. In contrast, first-generation activity controlled pacemakers showed a less physiological rate behavior with higher pacing rate (113 +/- 7 beats/min) walking downstairs than walking upstairs (97 +/- 9). For everyday activities at normal walking speed, accelerometer controlled pacemakers show a more physiological rate behavior than first-generation pacemakers, but they lose this physiological response with faster walking.

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Indications for Implanting Rate-Adaptive Cardiac Pacemakers

Cited by 3 publications

References 28 publications

Can Current Minute Ventilation Rate Adaptive Pacemakers Provide Appropriate Chronotropic Response in Pediatric Patients?

Can Current Minute Ventilation Rate Adaptive Pacemakers Provide Appropriate Chronotropic Response in Pediatric Patients?

Intrinsic Heart Rate Response as a Predictor of Rate-Adaptive Pacing Benefit

Activity Controlled Cardiac Pacemakers During Stairwalking: A Comparison of Accelerometer with Vibration Guided Devices and with Sinus Rate

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