Document Detail

Rate response of a closed-loop stimulation pacing system to changing preload and afterload conditions.
MedLine Citation:
PMID:  12914629     Owner:  NLM     Status:  MEDLINE    
Closed-loop stimulation (CLS) is a new sensor concept for rate adaptive pacing measuring changes in the unipolar right ventricular impedance, which correlates to changes of the right ventricular contractility and reflects the autonomic nervous innervation of the heart. Some patients do not tolerate the CLS mode because of inappropriate tachycardia, mainly related to postural changes. This study tested if the rate response of the CLS sensor is influenced not only by myocardial contractility but also by rapid changes in right ventricular filling. In 12 patients (10 men, median age 77 years) with a Biotronik Inos(2)-CLS DDDR pacemaker and 14 controls (13 men, median age 59 years) head-up tilt and handgrip testing was performed to provoke rapid changes in pre- and afterload. Tilting the pacemaker patients resulted in a nonphysiological steep increase of the sensor rate (increase >20 beats/min, peak after 1 minute, return to baseline within 2-3 minutes), which was significantly different from the control group, showing only a slight rise in intrinsic heart rate immediately after tilting. Simultaneously to the rapid increase in sensor rate, the pacemaker patients showed a marked orthostatic decline of systolic blood pressure. During handgripping, heart rate and blood pressure curves were similar in both groups. In patients with this CLS pacemaker, rapid preload reduction during head-up tilting caused an overshooting sensor rate increase, reproducing the authors' clinical observation of postural pacemaker tachycardia in some patients. Consequently, they concluded that the rate response of the CLS pacing system can be inappropriately influenced by rapid shifts of blood volume, affecting right ventricular filling.
Thomas A Cron; Christos D Pouskoulas; Dagmar I Keller; Christian E Zaugg; Peter T Buser; Matthias E Pfisterer; Stefan Osswald; Patrick Hilti; Hartmut Schächinger
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Pacing and clinical electrophysiology : PACE     Volume:  26     ISSN:  0147-8389     ISO Abbreviation:  Pacing Clin Electrophysiol     Publication Date:  2003 Jul 
Date Detail:
Created Date:  2003-08-13     Completed Date:  2003-12-04     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  7803944     Medline TA:  Pacing Clin Electrophysiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1504-10     Citation Subset:  IM    
Divisions of Cardiology Psychosomatic Medicine, University Hospital, Basel, Switzerland.
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MeSH Terms
Aged, 80 and over
Autonomic Nervous System / physiopathology
Blood Pressure
Cardiac Pacing, Artificial* / methods
Hand Strength
Heart / innervation
Heart Rate
Middle Aged
Myocardial Contraction
Pacemaker, Artificial*
Tilt-Table Test
Ventricular Function, Right

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

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