The Incremental Benefit of Rate-Adaptive Pacing on Exercise Performance During Cardiac Resynchronization Therapy

Tse, Hung‐Fat; Siu, Chung‐Wah; Lee, Kathy L.F.; Fan, Katherine; Chan, Hoi Yan; Tang, May; Tsang, Vella; Lee, Stephen W.L.; Lau, Chu‐Pak

doi:10.1016/j.jacc.2005.02.097

Cited by 92 publications

(62 citation statements)

References 24 publications

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“…Whether CI can be overcome by alternate means, including rate-adaptive pacing, as suggested by Tse et al, 15 remains an intriguing area of research. …”

Section: Discussionmentioning

confidence: 99%

“…9,12,13 This finding has informed the development of new therapies, such as rate-responsive pacing, with the goal of improving exercise tolerance in this patient population. 14,15 However, in patients with HF who are taking β-blockers, controversy exists about whether CI and exercise intolerance are effects of disease progression alone or whether they also can be attributed to pharmacological β-blockade. Nonetheless, discontinuation of β-blockers to allow for a higher HR is problematic given the substantial survival benefit derived from these agents in HF.…”

Section: Clinical Perspective On P 565mentioning

confidence: 99%

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Effect of β-Blocker Cessation on Chronotropic Incompetence and Exercise Tolerance in Patients With Advanced Heart Failure

Hirsh

Mignatti

Garan

et al. 2012

Circ: Heart Failure

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All patients with systolic HF, New York Heart Association class II to IV, receiving β-blocker therapy (bisoprolol, carvedilol, or metoprolol) for ≥3 months referred for cardiopulmonary exercise tolerance testing (CPETT) were screened. All patients were followed at the Columbia © 2012 American Heart Association, Inc. Background-Chronotropic incompetence is defined as the inability to reach 80% of heart rate (HR) reserve or 80% of the maximally predicted HR during exercise. The presence of chronotropic incompetence is associated with reduced peak oxygen consumption, and rate-responsive pacing therapy is under investigation to improve exercise capacity in heart failure (HF). However, uncertainty exists about whether chronotropic incompetence and reduced exercise tolerance in HF are attributable to β-blockade. Methods and Results-Subjects with HF and receiving long-term β-blocker therapy underwent cardiopulmonary exercise tolerance testing under 2 conditions in random sequence: (1) after a 27-hour washout period (Off-BB) and (2) 3 hours after β-blocker ingestion (On-BB). Norepinephrine levels were drawn at rest and at peak exercise. β1-response to norepinephrine was assessed using the chronotropic responsiveness index: ΔHR/Δlog norepinephrine. Nineteen patients with systolic HF (left ventricular ejection fraction, 22.8±7.7%) were enrolled. Mean age was 49.4±12.3 years. Average carvedilol equivalent dose was 29.1±17.0 mg daily. Peak HR off/on β-blockers was 62.7±18.7% and 51.4±18.2% HR reserve (P<0.01) and 79.1±11.0% and 70.3±12.3% maximally predicted HR (P<0.01). For the Off-BB and On-BB conditions, the respiratory exchange ratios were 1.05±0.06 and 1.05±0.10 (P=0.77), respectively, confirming maximal and near identical effort in both conditions. The peak oxygen consumption was 16.6±3.34 and 15.9±3.31 mL/kg/min (P=0.03), and the chronotropic responsiveness index was 19.3±7.2 and 16.2±7.1 (P=0.18). Conclusions-Acute β-blocker cessation does not normalize the chronotropic response to exercise in patients with advanced HF and chronotropic incompetence. (Circ Heart Fail. 2012;5:560-565.)Key Words: heart failure ◼ chronotropic incompetence ◼ β-blocker ◼ heart rate ◼ exercise Effect of β-Blocker Hirsh et al β-Blocker Cessation and CI in CHF 561University Medical Center Heart Failure Center by HF specialists. β-blockers were routinely uptitrated by physicians or nurse practitioners unless limited by blood pressure, bradycardia, fatigue, or other symptoms, possibly attributable to β-blockers. Patients were excluded if they had any of the following: atrial fibrillation or atrial flutter, inability to exercise, hospital admission for HF or acute coronary syndrome in the past 90 days or symptoms of myocardial ischemia, or inability to undergo a treadmill exercise test (eg, severe obstructive pulmonary disease or severe osteoarthritis). CI was not a factor in enrollment. Carvedilol equivalent dose was calculated for patients treated with bisoprolol and metoprolol based on the equivalence ratios established by the Metoprolol ...

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“…Whether CI can be overcome by alternate means, including rate-adaptive pacing, as suggested by Tse et al, 15 remains an intriguing area of research. …”

Section: Discussionmentioning

confidence: 99%

Section: Clinical Perspective On P 565mentioning

confidence: 99%

Effect of β-Blocker Cessation on Chronotropic Incompetence and Exercise Tolerance in Patients With Advanced Heart Failure

Hirsh

Mignatti

Garan

et al. 2012

Circ: Heart Failure

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“…Rate-responsive pacing has been demonstrated to improve cardiovascular exercise response in pacemaker patients 14,15 and heart failure patients receiving cardiac resynchronization therapy. 16 A recent study reported a 38% incidence of chronotropic incompetence in ICD recipients, 17 but the utility of rate-adaptive pacing has not been studied in this population.…”

Section: Clinical Perspective P 16mentioning

confidence: 99%

Is Dual-Chamber Programming Inferior to Single-Chamber Programming in an Implantable Cardioverter-Defibrillator?

et al. 2007

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Background-The INTRINSIC RV (Inhibition of Unnecessary RV Pacing with AVSH in ICDs) study tested the hypothesis that dual-chamber rate-responsive (DDDR) with atrioventricular search hysteresis (AVSH) 60-130 programming is not inferior to single-chamber (VVI)-40 programming in an implantable cardioverter defibrillator with respect to all-cause mortality and heart failure hospitalizations using an equivalence margin of 5%. Methods and Results-At 108 centers, 1530 patients with an implantable cardioverter defibrillator indication received a VITALITY AVT (Guidant Corporation, St. Paul, Minn) implantable cardioverter defibrillator programmed consistently to DDDR AVSH 60-130 for the first week. Of those, 988 patients with Ͻ20% right ventricular pacing at 1 week were randomized to DDDR AVSH 60-130 or to VVI-40 programming. Among those randomized, 502 were assigned to DDDR AVSH and 486 to VVI. Groups were similar with regard to coronary disease (68%), gender (21% female), and New York Heart Association functional class ϾI (79%). A total of 32 patients (6.4%) in the DDDR AVSH arm and 46 patients (9.5%) in the VVI arm died or were hospitalized for heart failure during a mean follow-up of 10.4 months (relative riskϭ0.67, Pϭ0.072 in favor of DDDR AVSH). DDDR AVSH was not inferior to VVI programming (PϽ0.001). All-cause mortality was not significantly different between the DDDR AVSH arm (3.6%) and the VVI arm

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“…Несмотря на большое разнообразие сенсоров, в настоящее время преобладают ЭКС со встроенным аксе-лерометром, который реагирует на линейное механиче-ское ускорение и генерирует электрический сигнал про-порционально амплитуде движения. Многочисленные исследования доказали улучшение переносимости физи-ческой нагрузки у пациентов с ХН при активации режима частотной адаптации как при наличии, так и в отсутствие СН [4,9,15,37].…”

Section: хронотропная некомпетентностьunclassified

Importance of the heart failure mechanisms during permanent single-chamber cardiac pacing for optimization of rate-adaptive mode

Kuznetsova¹,

Андреев²,

Сыркин³

et al. 2015

Kardiol. serdechno-sosud. khir.

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При постоянной электрокардиостимуляции сердца риск сердечной недостаточности (СН) повышен. В настоящем обзоре освещены механизмы развития СН при однокамерной электрокардиостимуляции сердца и основные подходы к преодолению данной проблемы. Особое внимание уделено обсуждению возможностей оптимизации режима частотной адаптации для уменьшения СН. Ключевые слова: постоянная однокамерная электрокардиостимуляция сердца, апикальная правожелудочковая стимуля-ция, хронотропная некомпетентность, сердечная недостаточность, режим частотной адаптации.The risk of heart failure in increased in case of permanent cardiac pacing. Heart failure mechanisms during permanent singlechamber cardiac pacing and main approaches to overcome these problems are being discussed in the review. Possibilities to optimize rate-adaptive modes for heart failure reducing are emphasized.Keywords: permanent single-chamber cardiac pacing, apical right ventricular pacing, chronotropic incompetence, heart failure, rate-adaptive mode.

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The Incremental Benefit of Rate-Adaptive Pacing on Exercise Performance During Cardiac Resynchronization Therapy

Abstract: In heart failure patients with severe chronotropic incompetence as defined by failure to achieve >70% AP-HR, appropriate use of rate-adaptive pacing with CRT provides incremental benefit on exercise capacity during exercise.

Cited by 92 publications

References 24 publications

Effect of β-Blocker Cessation on Chronotropic Incompetence and Exercise Tolerance in Patients With Advanced Heart Failure

Effect of β-Blocker Cessation on Chronotropic Incompetence and Exercise Tolerance in Patients With Advanced Heart Failure

Is Dual-Chamber Programming Inferior to Single-Chamber Programming in an Implantable Cardioverter-Defibrillator?

Importance of the heart failure mechanisms during permanent single-chamber cardiac pacing for optimization of rate-adaptive mode

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