Closed Loop Stimulation is Effective in Improving Heart Rate and Blood Pressure Response to Mental Stress: Report of a Single‐Chamber Pacemaker Study in Patients with Chronotropic Incompetent Atrial Fibrillation
- 9 June 2012
- journal article
- research article
- Published by Wiley in Pacing and Clinical Electrophysiology
- Vol. 35 (8), 990-998
- https://doi.org/10.1111/j.1540-8159.2012.03445.x
Abstract
Introduction: Closed-loop stimulation (CLS) is a form of rate-adaptive pacing capable of providing an effective pacing rate profile not only during physical exercise but also during mental stress. To test its effectiveness, CLS and accelerometer sensor (AS) rate response were compared intraindividually during a mental stress test (MST). Methods: Thirty-six patients (mean age 78.9 ± 6.4 years) implanted with a pacemaker with the CLS algorithm (Cylos, Biotronik, Berlin, Germany) underwent MSTs in different pacing configurations: nonrate-adaptive mode (VVI), AS mode (VVIR), and CLS mode, respectively. A modified Stroop test was used in order to induce mental stress. Heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure, and pacing percentage burden were collected for 5 minutes before, during, and 5 minutes after the test. Results: Mean peak-HR during MST was significantly higher in CLS configuration than in VVIR and VVI modes (92.8 ± 12.6 vs 78.9 ± 6.5 vs 77.8 ± 7.5; P ≤ 0.001). The average HR increase during MST was also higher in CLS configuration than in VVIR and VVI modes (22.7 ± 16.7 vs 8.2 ± 8.6 vs 6.6 ± 6.3; P ≤ 0.001). The percentage of pacing beats during MST was higher in CLS configuration than with the other two algorithms (48.4 ± 17.9 vs 27.4 ± 17.5 vs 25.8 ± 17.6; P ≤ 0.001). The average peak-SBP was significantly higher during MST in CLS mode than in VVIR and VVI configurations (172.6 ± 15.5 vs 156.7 ± 12.2 vs 145.5 ± 13.7; P ≤ 0.001). The mean SBP increase showed a similar behavior (51.8 ± 24.7 vs 18.4 ± 13.7 vs 16.4 ± 10.3; P ≤ 0.001). Conclusion: CLS algorithm in a single-chamber device is more effective than AS in detecting an hemodynamic demand due to an emotional stress and supplying a proper HR increase. These results are even more surprising compared to previous data in dual-chamber pacemakers, because they imply that CLS algorithm can provide an appropriate rate-modulation in patients with AF and chronotropic incompetence. (PACE 2012; 35:990–998)Keywords
This publication has 20 references indexed in Scilit:
- Usefulness of Hemodynamic Sensors for Physiologic Cardiac Pacing in Heart Failure PatientsCardiology Research and Practice, 2011
- Physical Activity, Disability, and Quality of Life in Older AdultsPhysical Medicine and Rehabilitation Clinics of North America, 2010
- Closed loop stimulation and accelerometer-based rate adaptation: results of the PROVIDE studyEP Europace, 2008
- Heart Rate Changes during Acute Mental Stress with Closed Loop Stimulation: Report on Two Single-Blinded, Pacemaker StudiesPacing and Clinical Electrophysiology, 2007
- Chronotropic incompetence—Part II: Clinical implicationsClinical Cardiology, 1996
- Response of the QT-sensing, rate-adaptive ventricular pacemaker to mental stressAmerican Heart Journal, 1993
- Comparison of the normal sinus node with seven types of rate responsive pacemaker during everyday activity.Heart, 1990
- QT‐Related Rate‐Responsive Pacing During Acute Myocardial InfarctionPacing and Clinical Electrophysiology, 1988
- Relation between QT interval and heart rate. New design of physiologically adaptive cardiac pacemaker.Heart, 1981