Rate responsive pacing using cardiac resynchronization therapy in patients with chronotropic incompetence and chronic heart failure

Sims, Daniel B.; Mignatti, Andrea; Colombo, P.C.; Uriel, Nir; García, Luis I.; Ehlert, Frederick A.; Jorde, Ulrich P.

doi:10.1093/europace/eur127

Cited by 37 publications

(35 citation statements)

References 17 publications

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“…It should therefore be of no surprise that CI has frequently been associated with increased risks of major cardiovascular events and premature death [17,[33][34][35]. For example, in one study, patients with CI were at a 2.5-fold greater risk of premature death and experienced a greater need for cardiac transplantation and ventricular assist device placement [33]. Moreover, the worse the degree of CI during exercise testing, the greater the risk of adverse cardiovascular events becomes [34].…”

Section: Prognosis and Clinical Consequences Of CI In T2dmmentioning

confidence: 99%

“…Rate-responsive pacing, as a pacemaker-based therapy to modulate severe CI and to improve maximal exercise capacity, has been used in previous studies and in other populations [33,68]. Rate-adaptive pacing has been shown to enhance functional capacity in patients with an inadequate chronotropic response [18] by restoring cardiac output changes during exercise.…”

Section: Cardiac Devicesmentioning

confidence: 99%

See 1 more Smart Citation

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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Section: Prognosis and Clinical Consequences Of CI In T2dmmentioning

confidence: 99%

Section: Cardiac Devicesmentioning

confidence: 99%

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

2015

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“…The other six patients had dual-chamber pacemakers that did sense from atrial depolarizations. In addition to having an HR response that is not intrinsically linked to metabolic demand or central command, another potential reason for some of the observed discordance between %HRR and %V O 2 R is that individuals who have heart failure, and are paced, may exhibit more chronotropic incompetence (12). Until more studies are conducted, the use of HRR as a measure of exercise intensity %V O 2 R (all subjects) 95% CI 45% T 2% (41%-50%) 54% T 2% (50%-58%) 63% T 2% (59%-67%) 72% T 2% (69%-75%) 81% T 2% (78%-84%) %V O 2 R (nonpaced) 95% CI 41% T 2% (36%-46%) 50% T 2% (46%-55%) 60% T 2% (56%-64%) 69% T 2% (66%-73%) 79% T 2% (75%-82%) %V O 2 R (paced) 95% CI 52% T 4% (45%-60%) 60% T 3% (54%-67%) 68% T 3% (63%-74%) 77% T 2% (72%-81%) 85% T 2% (80%-89%)…”

Section: Discussionmentioning

confidence: 99%

Heart Rate and V˙O2 Concordance in Continuous-Flow Left Ventricular Assist Devices

Kerrigan

Williams

Brawner

et al. 2016

Medicine &Amp; Science in Sports &Amp; Exercise

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“…The fact that QRSd did not narrow with response to therapy was not unexpected given the short AV interval and the numerous reports that show unchanged or even widened QRSds in therapy responders. 30,38,39 Critique of method These experiments were not done in chronically diseased hearts, which is required for BiV therapy indication in humans. 1 -3 Therefore, application of these findings in acute ischemia to chronically diseased, human, failing hearts requires further validation.…”

Section: Discussionmentioning

confidence: 99%

Bi-ventricular pacing improves pump function only with adequate myocardial perfusion in canine hearts with pseudo-left bundle branch block

Svendsen

Prinzen

Das

et al. 2012

Exp Biol Med (Maywood)

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Bi-ventricular (BiV) pacing is an effective therapy for the treatment of cardiac electromechanical (EM) dysfunction. The reason(s), however, for therapy non-response in approximately one-third of the subjects remains unclear, especially as it relates to myocardial perfusion and pacing location. In this study, we examined how acute BiV pacing response may be related to underlying myocardial perfusion coupled with pacing near or distant to the area of perfusion. In 10 open-chest anesthetized canines, coronary blood flow to the left ventricular (LV) anterior wall (AW: n = 5) and lateral wall (LW: n = 5) was controlled during four pacing conditions: right atrial, right ventricular (pseudo-left bundle branch block; [pseudo-LBBB]), BiV-LW and BiV-AW. Local EM function (piezo-electrical crystals and electrodes), along with global hemodynamic parameters, were measured during all pacing conditions at three coronary perfusion rates (≥0.40 mL/min/g, 0.20-0.40 mL/min/g and <0.20 mL/min/g). A positive BiV therapy response was assessed by a significant increase in the maximum cardiac output compared with the pseudo-LBBB condition. Despite no improvement in QRS duration, BiV-LW pacing improved LV function compared with the pseudo-LBBB pacing condition (P value <0.01). This improvement with BiV-LW pacing was seen above a certain myocardial perfusion threshold and was independent of any increases in regional coronary blood flow with BiV pacing. At lower myocardial perfusion rates, LV function was not improved with BiV pacing at any location. This study underscores the significance of even mild ischemia on BiV pacing response.

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Rate responsive pacing using cardiac resynchronization therapy in patients with chronotropic incompetence and chronic heart failure

Cited by 37 publications

References 17 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

Heart Rate and V˙O2 Concordance in Continuous-Flow Left Ventricular Assist Devices

Bi-ventricular pacing improves pump function only with adequate myocardial perfusion in canine hearts with pseudo-left bundle branch block

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