Individual Optimization of Pacing Sensors Improves Exercise Capacity without Influencing Quality of Life

Erol‐Yilmaz, Ayten; Schrama, T. A. M.; Tanka, Jutta Schroeder; Tijssen, Jan G.P.; Wilde, Arthur A.M.; Tukkie, Raymond

doi:10.1111/j.1540-8159.2005.09382.x

Cited by 12 publications

(12 citation statements)

References 26 publications

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“…This blending principle allows the MV sensor to drive the sensor-indicated rate after exercise is initiated and has been shown to restore chronotropic competence 26. Sensor optimization with RAP is important 35, therefore implanted patients will perform a hall walk to optimize sensor settings prior to undergoing the 1 mo. exercise test evaluation.…”

Section: Methodsmentioning

confidence: 99%

The Restoration of Chronotropic CompEtence in Heart Failure PatientS with Normal Ejection FracTion (RESET) Study: Rationale and Design

Kass

Kitzman

Alvarez

2010

Journal of Cardiac Failure

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Background Heart failure with preserved ejection fraction (HFpEF) is the predominant form of HF among the elderly and in women. However, there are few if any evidence-based therapeutic options for HFpEF. The chief complaint of HFpEF is reduced tolerance to physical exertion. Recent data revealed that one potential mechanism of exertional intolerance in HFpEF patients is inadequate chronotropic response. Although there is considerable evidence demonstrating the benefits of rate-adaptive pacing (RAP) provided from implantable cardiac devices in patients with an impaired chronotropic response, the effect of RAP in HFpEF is unknown. Methods and Results The RESET study is a prospective, multi-center, double-blind, randomized with stratification, study assessing the effect of RAP on peak VO2 and quality of life. RAP therapy will be evaluated in a cross-over paired fashion for each patient within each study stratum. Study strata are based on patient beta-blocker usage at time of enrollment. The study is powered to assess the impact of pacing independently in both strata. Conclusions The RESET study seeks to evaluate the potential benefit of RAP in patients with symptomatic mild to moderate HFpEF and chronotropic impairment. Study enrollment began in July 2008.

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Section: Methodsmentioning

confidence: 99%

The Restoration of Chronotropic CompEtence in Heart Failure PatientS with Normal Ejection FracTion (RESET) Study: Rationale and Design

Kass

Kitzman

Alvarez

2010

Journal of Cardiac Failure

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“…The APPROPRIATE study will also attempt to limit RV pacing in order to isolate the evaluation of sinus node function. Finally, previous studies [10,18,19] have demonstrated that manufacturer determined nominal sensor settings may be too conservative to provide appropriate heart rate response during exercise. These findings strongly suggest that individual patient optimization of the sensors is important to achieve optimal results.…”

Section: Discussionmentioning

confidence: 95%

“…Previous studies [10,18,19] have demonstrated that manufacturer determined nominal sensor settings may be too conservative to provide appropriate heart rate response during exercise, suggesting that the optimization of the sensors for each patient is important to achieve optimal results. Furthermore, it is possible that previous studies that have evaluated the effects of rate-modulated pacing may have not studied patient groups with true chronotropic incompetence.…”

Section: Introductionmentioning

confidence: 98%

Design and Rationale of the Assessment of Proper Physiologic Response with Rate Adaptive Pacing Driven by Minute Ventilation or Accelerometer (APPROPRIATE) Trial

Gilliam¹,

Giudici

Benn

et al. 2010

J. of Cardiovasc. Trans. Res.

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Rate-adaptive sensors are designed to restore a physiologic heart rate response to activity, in particular for patients that have chronotropic incompetence (CI). Limited data exist comparing two primary types of sensors; an accelerometer (XL) sensor which detects activity or motion and a minute ventilation (MV) sensor, which detects the product of respiration rate and tidal volume. The APPROPRIATE study will evaluate the MV sensor compared with the XL sensor for superiority in improving functional capacity (peak VO(2)) in pacemaker patients that have CI. This study is a double-blind, randomized, two-arm trial that will enroll approximately 1,000 pacemaker patients. Patients will complete a 6-min walk test at the 2-week visit to screen for potential CI. Those projected to have CI will advance to a 1-month visit. At the 1-month visit, final determination of CI will be done by completing a peak exercise treadmill test while the pacemaker is programmed to DDDR with the device sensors set to passive. Patients failing to meet the study criteria for CI will not continue further in the trial. Patients that demonstrate CI will be randomized to program their rate-adaptive sensors to either MV or XL in a 1:1 ratio. The rate-adaptive sensor will be optimized for each patient using a short walk to determine the appropriate response factor. At a 2-month visit, patients will complete a CPX test with the rate-adaptive sensors in their randomized setting.

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“…Shaber et al confirmed that conservative or nominal rate responsive settings may be suboptimal for many patients and that rate response optimization should be considered 38 . Further, exercise capacity and maximum heart rate were improved following 1 month of individual rate response optimization despite QOL remaining unchanged compared to patients with default sensor settings 39 …”

Section: Discussionmentioning

confidence: 99%

A Blended Sensor Restores Chronotropic Response More Favorably than an Accelerometer Alone in Pacemaker Patients: The LIFE Study Results

Coman

Freedman

Koplan

et al. 2008

Pacing Clinical Electrophis

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Individual Optimization of Pacing Sensors Improves Exercise Capacity without Influencing Quality of Life

Abstract: After 1 month of individual optimization of rate response pacemakers, exercise capacity was improved and maximum HR increased, although QOL remained unchanged. Accessible pacemaker sensor algorithms are mandatory for individual optimization.

Cited by 12 publications

References 26 publications

The Restoration of Chronotropic CompEtence in Heart Failure PatientS with Normal Ejection FracTion (RESET) Study: Rationale and Design

The Restoration of Chronotropic CompEtence in Heart Failure PatientS with Normal Ejection FracTion (RESET) Study: Rationale and Design

Design and Rationale of the Assessment of Proper Physiologic Response with Rate Adaptive Pacing Driven by Minute Ventilation or Accelerometer (APPROPRIATE) Trial

A Blended Sensor Restores Chronotropic Response More Favorably than an Accelerometer Alone in Pacemaker Patients: The LIFE Study Results

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