Predictors of chronotropic incompetence in the pacemaker patient population

Melzer, Christoph; Witte, J.; Reibis, Rona; Bondke, Hansjürgen; Combs, William; Stangl, Karl; Baumann, Gert; Theres, Heinz

doi:10.1093/europace/euj017

Cited by 15 publications

(18 citation statements)

References 36 publications

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“…Here, METs stage equals VO 2 (mL/kg/min)/3.5 at the respective stage, and METs peak equals VO 2 (mL/kg/min)/ 3.5 under maximum stress [31].…”

Section: Prevalence and Assessment Methodologymentioning

confidence: 99%

“…Because CI leads to a suppressed (increase in) cardiac output, perfusion of working muscles will be compromised. This can lead to severe or symptomatic exercise intolerance [6,18,31,32]. Subsequently, T2DM patients who experience CI during exercise will be very likely to suffer from exercise intolerance, a reduced quality of life and reduced motivation to exercise.…”

Section: Prognosis and Clinical Consequences Of CI In T2dmmentioning

confidence: 99%

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Chronotropic Incompetence During Exercise in Type 2 Diabetes: Aetiology, Assessment Methodology, Prognostic Impact and Therapy

2015

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During incremental exercise tests, chronotropic incompetence (CI), which is the inability of the heart rate (HR) to rise in proportion to an increase in metabolic demand, is often observed in patients with type 2 diabetes mellitus (T2DM). Despite the fact that CI is associated with exercise intolerance and elevated risks of development of cardiovascular disease and premature death, this clinical anomaly is often ignored or overlooked by clinicians and physiologists. CI is, however, a significant clinical abnormality that deserves further attention, examination and treatment. The aetiology of CI in T2DM remains poorly understood and is complex. Certain T2DM-related co-morbidities or physiological anomalies may contribute to development of CI, such as altered blood catecholamine and/or potassium levels during exercise, structural myocardial abnormalities, ventricular and/or arterial stiffness, impaired baroreflex sensitivity and cardiovascular autonomic neuropathy. Clinicians should thus be aware of the potential presence of yet undetected anomalies or diseases in T2DM patients who experience CI during exercise testing. However, an effective treatment for CI in T2DM is yet to be developed. Exercise training programmes seem to be the only potentially effective and feasible interventions for partial restoration of the chronotropic response in T2DM, but it remains poorly understood how these interventions lead to restoration of the chronotropic response. Studies are thus warranted to elucidate the aetiology of CI and develop an effective treatment for CI in T2DM. In particular, the impact of (different) exercise interventions on CI in T2DM deserves greater attention in future studies.

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“…Here, METs stage equals VO 2 (mL/kg/min)/3.5 at the respective stage, and METs peak equals VO 2 (mL/kg/min)/ 3.5 under maximum stress [31].…”

Section: Prevalence and Assessment Methodologymentioning

confidence: 99%

Section: Prognosis and Clinical Consequences Of CI In T2dmmentioning

confidence: 99%

Chronotropic Incompetence During Exercise in Type 2 Diabetes: Aetiology, Assessment Methodology, Prognostic Impact and Therapy

2015

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“…In addition, assessment of chronotropic incompetence with exercise stress testing in patients with pacemakers is useful, with a lower exercise duration and peak V O 2 noted in chronotropically incompetent patients. 112 Cardiac resynchronization therapy in patients with heart failure may benefit from evaluation and follow-up with exercise testing. Successful cardiac resynchronization therapy results in improvement in distance walked in 6 minutes and peak V O, 113,114 likely because of improved autonomic nervous system modulation.…”

Section: Pacemakersmentioning

confidence: 99%

Assessment of Functional Capacity in Clinical and Research Settings

Arena¹,

Myers²,

Williams³

et al. 2007

Circulation

498

219

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“…especially beneficial in patients that have chronotropic incompetence (CI), or an attenuated exercise heart rate response [1][2][3]. Depending on the definition used, CI has been identified in anywhere from 9% to 84% of patients [4][5][6][7][8][9][10] and has been associated with adverse outcomes and poor prognosis [11][12][13][14]. CI in paced patients has been associated with reduced VO 2 [9,15] while rate responsive programming in these patients has been associated with improvement in exercise tolerance [16,17].…”

Section: Introductionmentioning

confidence: 99%

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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Predictors of chronotropic incompetence in the pacemaker patient population

Abstract: We found the following characteristics predictive of CI in this pacemaker patient population: VO(2) max, existence of coronary artery disease or acquired valvular heart disease, previous cardiac surgery, as well as medication with digitalis, beta blockers, and amiodarone.

Cited by 15 publications

References 36 publications

Chronotropic Incompetence During Exercise in Type 2 Diabetes: Aetiology, Assessment Methodology, Prognostic Impact and Therapy

Chronotropic Incompetence During Exercise in Type 2 Diabetes: Aetiology, Assessment Methodology, Prognostic Impact and Therapy

Assessment of Functional Capacity in Clinical and Research Settings

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

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