For gold, heart rate matters.

A 19-year-old woman presented with decreased exercise tolerance 3 years after orthotopic heart transplantation. Exercise capacity was severely reduced, with a maximal workload of 84 W, corresponding to 56% of the predicted value. After exclusion of other causes, insufficient heart rate response to exercise was considered as the major contributor to her decreased exercise tolerance. Correction of this problem with the implantation of an AAIR pacemaker dramatically improved her physical performance, allowing her to win 5 gold medals at the European Heart and Lung Transplant Games. This case report illustrates how pacemaker therapy can dramatically improve the symptoms and performance of patients with chronotropic incompetence.