固有心率反应作为频率适应性起搏获益的预测指标。

Intrinsic heart rate response as a predictor of rate-adaptive pacing benefit.

作者信息

Alt E U, Schlegl M J, Matula M M

机构信息

1. Medizinische Klinik, Technische Universität München, Germany.

出版信息

Chest. 1995 Apr;107(4):925-30. doi: 10.1378/chest.107.4.925.

DOI:10.1378/chest.107.4.925

PMID:7705155

Abstract

OBJECTIVE

More than half of the pacemaker systems now being implanted can be rate adaptively paced. Our objective was to determine which patients benefit from rate-adaptive pacing in terms of improvement in maximum performance and aerobic capacity.

METHODS

Thirty patients with implanted accelerometer-driven, rate-adaptive pacemakers underwent a standardized, ergospirometrically and maximally symptoms = limited cardiopulmonary exercise (CPX) stress test with both rate-adaptive and fixed-rate stimulation in a randomized order. The patients were divided into three groups depending on the intrinsic heart rate achieved during maximum workload: group 1 achieved < or = 90 beats per minute (bpm), group 2 achieved 90 to < or = 110 bpm, and group 3 achieved > 110 bpm.

RESULTS

Group 1 demonstrated a significant increase (p < or = 0.01) in maximum oxygen uptake from 16.4 +/- 5.6 mL/kg/min with fixed-rate pacing to 23.2 +/- 11.1 mL/kg/min (+ 41.5%) with rate-adaptive pacing. At the anaerobic threshold, oxygen uptake significantly increased (p < or = 0.01) from 11.8 +/- 2.7 mL/kg/min to 15.7 +/- 5 mL/kg/min (+33.1%). Group 2 patients showed an increase in maximum oxygen uptake from 23.3 +/- 5.4 mL/kg/min to 25.3 +/- 4.9 mL/kg/min (+8.5%, p < or = 0.05) as well as an increase in oxygen uptake at the anaerobic threshold from 15.9 +/- 2.6 mL/kg/min to 18.1 +/- 2.9 mL/kg/min (+13.8%, p < or = 0.05) with rate-adaptive pacing. Group 3 demonstrated no significant difference between the two pacing methods (from 25.6 +/- 9.4 mL/kg/min to 25.9 +/- 9.3 mL/kg/min and from 15.8 +/- 5.5 mL/kg/min to 16.3 +/- 6 mL/kg/min). No difference in maximum oxygen uptake and in oxygen uptake at the anaerobic threshold was evident among the three groups when paced rate adaptively (not significant).

CONCLUSION

The second-generation, accelerometer controlled rate-adaptive pacemakers used in testing enabled a stress-oriented heart rate increase and an age- and gender-dependent adequate matching of maximum performance. The benefit from a rate-adaptive system to the patient increases as his or her chronotropic reserve limitation became more pronounced.

摘要

目的

目前植入的起搏器系统中，超过半数可进行频率适应性起搏。我们的目的是确定哪些患者能从频率适应性起搏中受益，即最大运动能力和有氧能力得到改善。

方法

30例植入了由加速度计驱动的频率适应性起搏器的患者，以随机顺序接受了标准化的、症状限制的心肺运动（CPX）压力测试，分别采用频率适应性起搏和固定频率起搏。根据最大负荷时达到的固有心率，将患者分为三组：第1组达到每分钟90次或更少（bpm），第2组达到90至每分钟110次（bpm），第3组达到每分钟110次以上。

结果

第1组显示最大摄氧量有显著增加（p≤0.01），从固定频率起搏时的16.4±5.6 mL/kg/min增加到频率适应性起搏时的23.2±11.1 mL/kg/min（增加41.5%）。在无氧阈时，摄氧量从11.8±2.7 mL/kg/min显著增加（p≤0.01）至15.7±5 mL/kg/min（增加33.1%）。第2组患者的最大摄氧量从23.3±5.4 mL/kg/min增加到25.3±4.9 mL/kg/min（增加8.5%，p≤0.05），无氧阈时的摄氧量从15.9±2.6 mL/kg/min增加到18.1±2.9 mL/kg/min（增加13.8%，p≤0.05）。第3组在两种起搏方式之间无显著差异（从25.6±9.4 mL/kg/min到25.9±9.3 mL/kg/min，从15.8±5.5 mL/kg/min到16.3±6 mL/kg/min）。当进行频率适应性起搏时，三组之间在最大摄氧量和无氧阈时的摄氧量方面无明显差异（无显著性）。