Drago Fabrizio, Silvetti Massimo Stefano, De Santis Antonella, Grutter Giorgia, Calcagnini Giovanni, Censi Federica, Bartolini Pietro, Barbaro Vincenzo
Cardiology Division, Bambin Gesù Hospital, Rome, Italy.
Pacing Clin Electrophysiol. 2005 Mar;28(3):212-8. doi: 10.1111/j.1540-8159.2005.09431.x.
The aim of this study was to evaluate the efficacy of physiological rate-responsive pacemakers (Closed Loop Stimulation--CLS) to pace pediatric and late adolescent patients undergoing rest, mental, standing, and exercise testing. Dual-chamber pacemaker is increasingly indicated for young patients. A new physiological pacing mode based on the indirect measure of ventricular contractility (CLS), has shown interesting results in adults, while no data on pediatric patients are available. RR intervals and beat-to-beat systolic and diastolic pressures were monitored in 12 pediatric patients (6 males, mean age 17 years [12-22 years]) who had a transvenous implant of Inos2+-CLS dual-chamber pacemaker (Biotronik GmbH, Berlin, Germany) and endocardial leads. All the patients showed correct electrical parameters at the implant and during the follow-ups. Paced RR intervals decreased significantly (F = 7.28, P = 0.01) from 0.85 +/- 0.08 seconds (rest) to 0.73 +/- 0.10 seconds (mental) and to 0.75 +/- 0.010 seconds (standing); systolic/diastolic pressure was significantly higher (F = 12.2, P = 0.002/F = 13.6, P = 0.001) in mental (134.4 +/- 19.9/74.4 +/- 8.1 mmHg) with respect to rest (115.1 +/- 18.3/61.0 +/- 6.1 mmHg), and standing (118.7 +/- 23.9/67.3 +/- 0.1 mmHg). During exercise the paced RR interval showed significant decrease of about 35% from baseline to maximum load (F = 24.90, P = 0.001) and systolic pressure increased significantly (F = 4.91, P = 0.019) by about 34% from baseline to maximum load. The comparison between paced and spontaneous rates showed very similar values and trend. In addition, CLS mode does not seem to overrun the spontaneous heart activity, when present. This is a study to evaluate CLS pacing in pediatric and late adolescent patients. The study shows that CLS pacing responds to both physical and non-physical stressors, providing physiological pacing rates, as previously observed in adults.
本研究的目的是评估生理性频率应答起搏器（闭环刺激——CLS）对接受静息、精神应激、站立及运动测试的儿科和青少年晚期患者进行起搏的疗效。双腔起搏器越来越多地应用于年轻患者。一种基于心室收缩力间接测量的新型生理性起搏模式（CLS）在成人中已显示出有趣的结果，但尚无关于儿科患者的数据。对12例儿科患者（6例男性，平均年龄17岁[12 - 22岁]）进行了研究，这些患者经静脉植入了Inos2 + -CLS双腔起搏器（德国柏林百多力公司）及心内膜导线，并监测了RR间期以及逐搏收缩压和舒张压。所有患者在植入时及随访期间电参数均正常。起搏RR间期从静息时的0.85±0.08秒显著降低（F = 7.28，P = 0.01）至精神应激时的0.73±0.10秒以及站立时的0.75±0.010秒；精神应激时收缩压/舒张压（134.4±19.9/74.4±8.1 mmHg）显著高于静息时（115.1±18.3/61.0±6.1 mmHg）和站立时（118.7±23.9/67.3±0.1 mmHg）（F = 12.2，P = 0.002/F = 13.6，P = 0.001）。运动期间，起搏RR间期从基线到最大负荷显著降低约35%（F = 24.90，P = 0.001），收缩压从基线到最大负荷显著升高约34%（F = 4.91，P = 0.019）。起搏频率与自发频率之间的比较显示出非常相似的值和趋势。此外，当存在自发心脏活动时，CLS模式似乎不会超过自发心脏活动。这是一项评估儿科和青少年晚期患者CLS起搏的研究。该研究表明，CLS起搏对身体和非身体应激源均有反应，可提供生理性起搏频率，这与之前在成人中观察到的情况相同。
