Greco Enrico Maria, Ferrario Marco, Romano Salvatore
Cardiology Department, Uboldo Hospital, Cernusco sul Naviglio, Milan, Italy.
Pacing Clin Electrophysiol. 2003 Apr;26(4 Pt 1):812-8. doi: 10.1046/j.1460-9592.2003.t01-1-00144.x.
An innovative control parameter for rate responsive (RR) pacing that uses a sensor to measure mechanical vibrations generated by the myocardium during the isovolumetric contraction phase (peak endocardial acceleration [PEA]), has been devised by SORIN Biomedica (BEST Living System). To assess the physiological sensitivity of the pacemaker sensor along with reliability of the algorithm to supply appropriate pacing rates three different relationships were examined (linear regression analysis): (1) recorded deltaPEA exercise steps against the calculated energy cost of exercise (MET), (2) exercise pacing rates against predicted values, and (3) deltaPEA against exercise pacing rates. Fifteen patients (mean age 68 +/- 12 years) in NYHA Class I-II, implanted with the BEST Living System (Living 1 DDDR pacemaker) for advanced AVB and/or SSS, underwent one of the following maximal exercise stress protocols: bicycle (25 W, 2-minute steps) or Bruce or Chronotropic Assessment Exercise Protocol (CAEP). Pacing rates for each step were matched against those predicted by a reliable and tested custom software called Pacing Rate Profile Software (PRPS). The PRPS is based on the oxygen pulse reserve (OPR) method (OPR = VO2 reserve divided by heart rate reserve), American College of Sports Medicine (ACSM) formulas for calculating workload/metabolic requirements, and data derived from the Weber functional classes. On the basis of certain patient, data the PRPS then supplies appropriate metabolic pacing rate profiles. In all 15 patients linear regression analysis of deltaPEA against MET, as evaluated during the exercise protocol steps, showed a high correlation (r = 0.97). Likewise, a high correlation was also obtained between PRPS predicted heart rates and exercise pacing rates (r = 0.96) and PEA against exercise pacing rates (r = 0.96). The results of this study show that, through PEA dynamic monitoring, the SORIN Best Living System produces physiological pacing rates that are significantly related to metabolic needs.
索林生物医学公司（最佳生活系统）设计了一种用于频率应答（RR）起搏的创新控制参数，该参数利用传感器测量等容收缩期心肌产生的机械振动（心内膜峰值加速度[PEA]）。为了评估起搏器传感器的生理敏感性以及算法提供适当起搏频率的可靠性，研究了三种不同的关系（线性回归分析）：（1）记录的ΔPEA运动步数与计算出的运动能量消耗（代谢当量），（2）运动起搏频率与预测值，以及（3）ΔPEA与运动起搏频率。15名纽约心脏协会I-II级患者（平均年龄68±12岁），因高级房室传导阻滞和/或病态窦房结综合征植入最佳生活系统（Living 1 DDDR起搏器），接受了以下最大运动应激方案之一：自行车运动（25瓦，2分钟递增）或布鲁斯运动或变时性评估运动方案（CAEP）。将每个步骤的起搏频率与一个名为起搏频率剖面软件（PRPS）的可靠且经过测试的定制软件预测的频率进行匹配。PRPS基于氧脉搏储备（OPR）方法（OPR = 氧耗储备除以心率储备）、美国运动医学学院（ACSM）计算工作量/代谢需求的公式以及从韦伯功能分级得出的数据。然后，PRPS根据某些患者数据提供适当的代谢起搏频率剖面。在所有15名患者中，在运动方案步骤中评估的ΔPEA与代谢当量的线性回归分析显示出高度相关性（r = 0.97）。同样，PRPS预测心率与运动起搏频率之间（r = 0.96）以及PEA与运动起搏频率之间（r = 0.96）也获得了高度相关性。这项研究的结果表明，通过PEA动态监测，索林最佳生活系统产生的生理起搏频率与代谢需求显著相关。
