Lau C P, Antoniou A, Ward D E, Camm A J
Department of Cardiological Sciences, St. George's Hospital Medical School, London, England.
Pacing Clin Electrophysiol. 1988 Nov;11(11 Pt 2):1815-22. doi: 10.1111/j.1540-8159.1988.tb06314.x.
A minute ventilation sensing rate modulated pacemaker was implanted in nine patients with bradycardia. Minute ventilation is sensed in this pacemaker by means of a standard bipolar pacing electrode. Compared with exercise in the constant rate ventricular pacing (VVI) mode at 1 month after pacemaker implantation, rate responsive pacing resulted in an improvement of exercise capacity of 33 +/- 5% (from 437 +/- 42 s in the VVI mode to 593 +/- 57 s in the rate modulated mode, P less than 0.01, Bruce protocol). This improvement was maintained in the seven patients in whom an exercise test was repeated at 3 months after implantation. The pacing rate was significantly correlated with oxygen consumption (r = 0.84 +/- 0.04) and measured minute ventilation (r = 0.76 +/- 0.06). Symptomatology in these patients was assessed by means of self-assessment questionnaires in a double blind, randomized cross-over study in which the pacemaker was alternatively programmed into the VVI and rate modulated modes. Significant improvements in "shortness of breath" and "energy during daily activities" were documented during rate modulated pacing and "palpitations" and "chest pain" were not worsened. Most patients preferred the rate modulated mode during the study. In conclusion, rate modulated pacing by sensing minute ventilation resulted in better exercise capacity and symptomatology. The pacing rate also showed good correlation with the individual's oxygen requirement.
为9例心动过缓患者植入了分钟通气量感知率调制起搏器。该起搏器通过标准双极起搏电极感知分钟通气量。与起搏器植入后1个月时以固定频率心室起搏（VVI）模式进行运动相比，频率应答性起搏使运动能力提高了33±5%（从VVI模式下的437±42秒提高到频率调制模式下的593±57秒，P<0.01，Bruce方案）。在植入后3个月重复进行运动试验的7例患者中，这种改善得以维持。起搏频率与耗氧量（r = 0.84±0.04）和测得的分钟通气量（r = 0.76±0.06）显著相关。在一项双盲、随机交叉研究中，通过自我评估问卷对这些患者的症状进行评估，在该研究中，起搏器交替编程为VVI模式和频率调制模式。在频率调制起搏期间，“呼吸急促”和“日常活动中的精力”有显著改善，且“心悸”和“胸痛”未加重。在研究期间，大多数患者更喜欢频率调制模式。总之，通过感知分钟通气量进行频率调制起搏可提高运动能力并改善症状。起搏频率也与个体的氧气需求显示出良好的相关性。
