Document Detail

Rate responsive pacemakers: a rapid assessment protocol.
MedLine Citation:
PMID:  18233972     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Rate responsive (RR) pacemakers are commonly implanted with nominal conservative factory-set responsiveness, which is usually accepted because established exercise protocols are time-consuming. We aimed for efficient assessment of RR pacemaker settings. METHODS: We tested exercise heart rates in controls and paced patients using a brief exercise test that approximates real-life levels of exertion. The test used a nonmotorized treadmill: 30 seconds walking at patient-determined speed followed by 15 seconds brisk exertion. Subjects totaled 110: 26 with RR pacemakers; 22 with non-RR pacers; 27 "sick" nonpaced control patients; and 35 healthy controls. Heart rate (HR) was measured prior to exercise, after 30 seconds of casual walk, after 15 seconds of brisk walk, and 1 minute into recovery. Testing required <5 minutes from set-up to recovery. RESULTS: The 26 RR pacer patients had a mean HR at rest = 74 +/- 10 beats per minute (bpm), walk = 87 +/- 14, and brisk = 94 +/- 18 (increase 27%). Non-RR pacer patients (n = 22): rest = 73 +/- 12 bpm, walk = 88 +/- 14, and brisk = 94 +/- 17 (increase 24.3%, P = 0.60 vs RR patients). "Sick" controls (n = 27): rest = 78 +/- 14 bpm, walk = 102 +/- 17, and brisk = 117 +/- 18 (increase 51.9%, P< 0.001 vs RR pts). For the healthy controls, HRs were at rest 83+/11 bpm, walk = 104 +/- 12, and brisk = 117 +/- 13 (P< 0.001 compared to both paced groups; P = NS vs sick controls). CONCLUSIONS: Nominal RR settings may be suboptimal for many patients. The nonmotorized treadmill test allows quick and inexpensive assessment of RR programming, with the potential for efficient RR optimization.
Justin D Shaber; John D Fisher; Indiresha Ramachandra; Christian Gonzalez; Lauren Rosenberg; Kevin J Ferrick; Jay N Gross; Soo G Kim
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Pacing and clinical electrophysiology : PACE     Volume:  31     ISSN:  1540-8159     ISO Abbreviation:  Pacing Clin Electrophysiol     Publication Date:  2008 Feb 
Date Detail:
Created Date:  2008-01-31     Completed Date:  2008-05-06     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7803944     Medline TA:  Pacing Clin Electrophysiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  192-7     Citation Subset:  IM    
Department of Medicine, Cardiology Division, Arrhythmia Service, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York 10467, USA.
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MeSH Terms
Analysis of Variance
Arrhythmias, Cardiac / physiopathology,  therapy*
Cardiac Pacing, Artificial / methods*
Case-Control Studies
Chi-Square Distribution
Exercise Test*
Heart Rate / physiology*
Pacemaker, Artificial*

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

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