Wonisch Manfred, Lercher Peter, Scherr Daniel, Maier Robert, Pokan Rochus, Hofmann Peter, von Duvillard Serge P
Department of Medicine, Division of Cardiology, Medical University, Graz, Austria.
Chest. 2005 Mar;127(3):787-93. doi: 10.1378/chest.127.3.787.
Patients with chronic heart failure and implanted cardioverter-defibrillators (ICDs) may have a higher incidence of new-onset or worsening heart failure requiring hospitalization with dual-chamber ICDs compared with single-chamber ICDs.
The purpose of this study was to show the impact of permanent right ventricular (RV) pacing on exercise capacity and related cardiorespiratory parameters in patients with chronic heart failure and ICDs.
Seventeen patients with chronic heart failure and a dual-chamber ICD performed cardiopulmonary exercise testing (CPX) on 3 different days. After CPX 1, patients were randomized either to back-up pacing or permanent RV pacing. After 3 months, CPX 2 was performed and patients changed groups (crossover design); CPX 3 was performed after 3 additional months.
Maximal values for workload (108 +/- 46 W vs 117 +/- 48 W, p < 0.01), oxygen uptake (Vo(2)) [21.0 +/- 5.3 mL/min/kg vs 22.5 +/- 6.4 mL/min/kg, p < 0.05], oxygen pulse (13 +/- 3.7 mL vs 14 +/- 4.0 mL, p < 0.05), and metabolic equivalent (6.0 +/- 1.5 vs 6.4 +/- 1.8, p < 0.05) were significantly lower with permanent RV pacing compared to back-up pacing. Workload, Vo(2), and oxygen pulse were significantly reduced at the ventilatory anaerobic threshold, while workload and Vo(2) were significantly lower at the respiratory compensation point. No differences were found for maximal heart rate, minute ventilation Ve, and respiratory exchange ratio. The Ve/carbon dioxide production slope was significantly steeper with permanent RV pacing compared to back-up pacing.
Permanent RV pacing significantly reduced maximal and submaximal measures of exercise. For patients with chronic heart failure and sufficient atrioventricular conduction, every effort should be made to minimize permanent right ventricular pacing.
与单腔植入式心脏复律除颤器（ICD）相比，慢性心力衰竭且植入双腔ICD的患者新发或恶化的心力衰竭需要住院治疗的发生率可能更高。
本研究的目的是表明永久性右心室（RV）起搏对慢性心力衰竭且植入ICD患者的运动能力及相关心肺参数的影响。
17例慢性心力衰竭且植入双腔ICD的患者在3个不同日期进行了心肺运动试验（CPX）。在CPX 1之后，患者被随机分为备用起搏组或永久性RV起搏组。3个月后，进行CPX 2，患者更换分组（交叉设计）；再过3个月后进行CPX 3。
与备用起搏相比，永久性RV起搏时的最大工作量（108±46W对117±48W，p<0.01）、摄氧量（Vo₂）[21.0±5.3mL/min/kg对22.5±6.4mL/min/kg，p<0.05]、氧脉搏（13±3.7mL对14±4.0mL，p<0.05）和代谢当量（6.0±1.5对6.4±1.8，p<0.05）显著降低。在通气无氧阈时，工作量、Vo₂和氧脉搏显著降低，而在呼吸补偿点时，工作量和Vo₂显著降低。最大心率、分钟通气量Ve和呼吸交换率未发现差异。与备用起搏相比，永久性RV起搏时的Ve/二氧化碳产生斜率显著更陡。
永久性RV起搏显著降低了运动的最大和次最大指标。对于慢性心力衰竭且房室传导足够的患者，应尽一切努力尽量减少永久性右心室起搏。
