Document Detail

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.
MedLine Citation:
PMID:  22680238     Owner:  NLM     Status:  Publisher    
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;XX:1-9).
Riccardo Proietti; Gianmauro Manzoni; Luigi DI Biase; Gianluca Castelnuovo; Leonida Lombardi; Camilla Fundarò; Nadia Vegliante; Giada Pietrabissa; Pasquale Santangeli; Robert A Canby; Antonio Sagone; Maurizio Viecca; Andrea Natale
Related Documents :
18326978 - Vascular compliance in the cardiometabolic syndrome.
16849888 - Pulse pressure and vascular risk in the elderly: associations and clinical implications.
8688758 - Cardiovascular risk factors in british children from towns with widely differing adult ...
10775558 - Arterial hypertension, microalbuminuria, and risk of ischemic heart disease.
2524288 - Fibrillar collagen and myocardial stiffness in the intact hypertrophied rat left ventri...
7546488 - Essential hypertension predicted by tracking of elevated blood pressure from childhood ...
Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-6-9
Journal Detail:
Title:  Pacing and clinical electrophysiology : PACE     Volume:  -     ISSN:  1540-8159     ISO Abbreviation:  -     Publication Date:  2012 Jun 
Date Detail:
Created Date:  2012-6-11     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7803944     Medline TA:  Pacing Clin Electrophysiol     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
©2012, The Authors. Journal compilation ©2012 Wiley Periodicals, Inc.
Cardiac Electrophysiology Laboratory, Luigi Sacco Hospital, Milan, Italy Istituto Auxologico Italiano IRCCS, Psychology Research Laboratory, Ospedale San Giuseppe, Verbania, Italy Department of Psychology, Catholic University of Milan, Milan, Italy Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas Department of Cardiology, University of Foggia, Foggia, Italy Department of Biomedical Engineering, University of Austin, Austin, Texas.
Export Citation:
APA/MLA Format     Download EndNote     Download BibTex
MeSH Terms

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

Previous Document:  Acute arsenic toxicity alters cytochrome P450 and soluble epoxide hydrolase and their associated ara...
Next Document:  The proteasome is responsible for caspase-3-like activity during xylem development.