Fearnot N E, Smith H J, Sellers D, Boal B
Purdue University, West Lafayette, Indiana 47907.
Pacing Clin Electrophysiol. 1989 Nov;12(11):1806-15. doi: 10.1111/j.1540-8159.1989.tb01867.x.
Temperature responsive pacemakers were implanted in 45 patients (ages 44 to 90); 31 patients were evaluated by randomized, paired treadmill exercise tests 1 month postimplant. Of 28 males and 17 females, 19 had coronary artery disease; 8 had congestive heart failure. Pacing indications included sinus node disease (26), atrial fibrillation (15), AV block (10), and brady/tachy syndrome (10); some had multiple indications. Blood temperature (every 10 seconds, resolution = 0.004 degrees C) and pacing rate (every minute) were telemetered from the pacemaker. Average heart rate, exercise duration (5.7 min VVI; 6.7 min VVIR), VVIR response time (22 sec), initial temperature drop (0.23 degrees C) and maximum rate of drop (0.65 degrees C/min), temperature rise (0.31 degrees C VVI; 0.38 degrees C VVIR) and rate of rise (0.27 degrees C/min) were studied in a subset of patients. In pacer-dependent patients, average paired increases in exercise duration and heart rate was 56% and 34%, respectively. Including all (31) patients, some with intermittent sinus rhythm, increases were 28% and 9%, respectively. Because exercise duration increased, temperature rise was higher with rate adaptation. Rate adaptation was obtainable in all patients and patients averaged 99 +/- 48 increases above basic pacing rate per day at nominal temperature sensitivity.
Beneficial rate adaptation is achievable using blood temperature to modify rate in a sensor based system.
45例患者（年龄44至90岁）植入了温度响应型起搏器；31例患者在植入后1个月通过随机配对平板运动试验进行评估。28例男性和17例女性中，19例患有冠状动脉疾病；8例患有充血性心力衰竭。起搏适应证包括窦房结疾病（26例）、心房颤动（15例）、房室传导阻滞（10例）和缓慢性/快速性心律失常综合征（10例）；部分患者有多种适应证。从起搏器遥测血温（每10秒，分辨率 = 0.004摄氏度）和起搏频率（每分钟）。在部分患者中研究了平均心率、运动持续时间（VVI为5.7分钟；VVIR为6.7分钟）、VVIR反应时间（22秒）、初始温度下降（0.23摄氏度）和最大下降速率（0.65摄氏度/分钟）、温度上升（VVI为0.31摄氏度；VVIR为0.38摄氏度）和上升速率（0.27摄氏度/分钟）。在起搏器依赖型患者中，运动持续时间和心率的平均配对增加分别为56%和34%。包括所有（31例）患者，部分患者有间歇性窦性心律，增加分别为28%和9%。由于运动持续时间增加，随着频率适应温度上升更高。所有患者均可实现频率适应，在标称温度敏感性下患者平均每天比基础起搏频率增加99±48次。
在基于传感器的系统中利用血温调节频率可实现有益的频率适应。
