Chen Wen-Ling, Chen Lung-Ching, Hsu Pei-Sung, Shyu Kou-Gi, Hung Huei-Fong, Lee Shih-Huang, Wang Tzu-Lin, Lai Wei-Ting, Chen Kuan-Jen, Liao Zhen-Yu, Chuang Cheng-Yen, Chou Ching-Yao, Chua Su-Kiat
School of Medicine, College of Medicine, Fu Jen Catholic University, New Taipei, 24205, Taiwan; Department of Physical Medicine and Rehabilitation, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan.
School of Medicine, College of Medicine, Fu Jen Catholic University, New Taipei, 24205, Taiwan; Division of Cardiology, Department of Internal Medicine, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan.
J Formos Med Assoc. 2025 Apr;124(4):326-332. doi: 10.1016/j.jfma.2024.10.009. Epub 2024 Oct 20.
Chronotropic incompetence (CI) severely limits exercise tolerance due to impaired heart rate responses. This study investigated whether pacemaker with closed-loop stimulation (DDD-CLS) pacing, which provides rate acceleration in response to exertion, could enhance lung function and cardiopulmonary capacity compared pacemaker without CLS pacing in patients with CI.
This randomized crossover trial included 32 patients with CI who were compared to each CLS and DDD pacing over 2 months. Spirometry was used to assess the forced vital capacity (FVC). Cycling-based cardiopulmonary exercise testing (CPET) measured peak oxygen uptake (peak VO).
DDD-CLS pacing yielded significantly higher FVC (2.2 ± 0.8 L) versus DDD pacing (2.0 ± 0.7 L), p = 0.036, a 3.2% improvement. Moreover, those in the DDD-CLS mode showed a significantly higher FEV1 of 1.8 ± 0.6 L compared to the DDD mode of 1.7 ± 0.5 L (p = 0.03). Compared with DDD pacing, DDD-CLS pacing also achieved superior peak VO (14.9 ± 4.0 vs 12.2 ± 3.7 mlO/kg/min, p < 0.001) and peak heart rate (106.9 ± 9.7 vs 98.3 ± 19.8 bpm, p = 0.013). DDD-CLS and DDD pacing modes showed significant correlations between FVC and peak VO and between peak VO and peak heart rate during CPET.
Compared with DDD mode, DDD-CLS pacing provided physiological chronotropic support to improve cardiopulmonary function during exertion, which enhanced lung capacity in patients with CI.
变时性功能不全（CI）由于心率反应受损，严重限制了运动耐力。本研究调查了具有闭环刺激功能（DDD-CLS）的起搏器起搏，即能根据运动增加心率，与无CLS功能的起搏器相比，能否增强CI患者的肺功能和心肺能力。
这项随机交叉试验纳入了32例CI患者，在2个月内分别采用CLS起搏和DDD起搏进行比较。采用肺活量测定法评估用力肺活量（FVC）。基于自行车运动的心肺运动试验（CPET）测量峰值摄氧量（peak VO）。
与DDD起搏（2.0±0.7L）相比，DDD-CLS起搏的FVC显著更高（2.2±0.8L），p = 0.036，改善了3.2%。此外，DDD-CLS模式下的FEV1为1.8±0.6L，显著高于DDD模式下的1.7±0.5L（p = 0.03）。与DDD起搏相比，DDD-CLS起搏的peak VO也更高（14.9±4.0 vs 12.2±3.7 mlO/kg/min，p < 0.001），峰值心率也更高（106.9±9.7 vs 98.3±19.8 bpm，p = 0.013）。在CPET期间，DDD-CLS和DDD起搏模式下FVC与peak VO之间以及peak VO与峰值心率之间均存在显著相关性。
与DDD模式相比，DDD-CLS起搏在运动期间提供了生理性变时性支持，以改善心肺功能，从而增强了CI患者的肺功能。
