Igawa O, Tomokuni A, Saitoh M, Kitamura H, Miyakoda H, Kotake H, Mashiba H, Itoh S, Kurogane H, Yoshida Y
First Department of Internal Medicine, Tottori University, Japan.
Pacing Clin Electrophysiol. 1990 Dec;13(12 Pt 2):1766-72. doi: 10.1111/j.1540-8159.1990.tb06887.x.
To investigate the sympathetic nervous system (SNS) responses and circulatory responses to exercise in eight patients (five male and three female) with complete atrioventricular block (CAVB) treated with atrioventricular (AV) synchronous pacing, a symptom-limited, multistaged treadmill stress test was performed, and plasma norepinephrine (NE) and circulatory parameters were measured at rest, at peak exercise, and in the recovery period. The eight patients were tested using the fixed AV interval (150 or 156 msec). Their exercise tolerance was generally poor. In all measured points, plasma NE levels were significantly higher in the eight study patients than those in the 12 normal subjects (eight male and four female). Systolic blood pressure (SBP) of CAVB patients elevated significantly after exercise compared to that at peak exercise. Heart rate (HR) responses of CAVB patients were characterized by their poor increase at peak exercise. These results suggest that some latent cardiac dysfunction continues in the CAVB patients however satisfactorily the AV synchronous pacing might perform. AV synchronous pacing with three different kinds of auto-atrioventricular delay (auto-AVD) was applied to three of the eight patients. In each AVD mode, a treadmill stress test was performed repeatedly according to the same protocol. Plasma NE concentrations under the condition with fixed AVD at peak exercise increased compared to those under the other two conditions with auto-AVD. These findings suggest that AV synchronous pacing with auto-AVD was better than that with fixed AVD during exercise. Plasma NE response to exercise seems to be a useful indicator for evaluating the condition of patients treated with DDD pacemakers and their adaptation for cardiac function.
为研究8例接受房室同步起搏治疗的完全性房室传导阻滞（CAVB）患者（5例男性，3例女性）运动时的交感神经系统（SNS）反应和循环反应，进行了一项症状限制性、多阶段平板运动试验，并在静息、运动峰值和恢复期测量了血浆去甲肾上腺素（NE）和循环参数。这8例患者采用固定房室间期（150或156毫秒）进行测试。他们的运动耐量普遍较差。在所有测量点，8例研究患者的血浆NE水平均显著高于12例正常受试者（8例男性，4例女性）。与运动峰值时相比，CAVB患者运动后的收缩压（SBP）显著升高。CAVB患者的心率（HR）反应特点是在运动峰值时升高较差。这些结果表明，CAVB患者中存在一些潜在的心脏功能障碍，无论房室同步起搏的效果如何理想。对8例患者中的3例应用了三种不同类型的自动房室延迟（auto-AVD）的房室同步起搏。在每种AVD模式下，按照相同方案重复进行平板运动试验。与其他两种auto-AVD条件相比，固定AVD条件下运动峰值时的血浆NE浓度升高。这些发现表明，运动期间auto-AVD的房室同步起搏优于固定AVD的起搏。血浆NE对运动的反应似乎是评估接受DDD起搏器治疗患者状况及其心脏功能适应性的有用指标。
