Epperlein S, Kreft A, Siegert V, Liebrich A, Himmrich E, Treese N
Klinik für Innere Medizin Kardiologie, Marienhospital Osnabrück.
Z Kardiol. 1996 Apr;85(4):226-36.
The purpose of this study was to assess cardiopulmonary exercise capacity, variation in heart rate during everyday activities, frequency of atrial arrhythmias and quality-of-life during accelerometer-based rate modulated dual-chamber pacing. Nine chronotropically incompetent and 14 chronotropically competent patients (mean age 51 years) were randomly assigned to DDD and DDDR mode and evaluated by a semisupine bicycle exercise testing exceeding the anaerobic threshold, 24-h Holter monitoring and a quality-of-life questionnaire. In the subgroup of patients with chronotropic incompetence, defined by a HR/VO2-ration, 2 beats/ml/kg, during DDDR pacing, compared to DDD, maximum heart rate increased from 83 +/- 13 to 132 +/- 7 beats/min (p < 0.01), maximum oxygen uptake from 12.7 +/- 3.1 to 15.3 +/- 3.2 ml/kg/min ( p < 0.05) and the VO2/WR-ratio from 8.1 +/- 1.0 to 9.0 +/- 0.9 ml/min/watts (p < 0.05). Exercise duration lengthened from 252 +/- 59 to 301 +/- 96 s (p < 0.05). During the 24-h Holter recordings the average maximum heart rate rose form 69 +/- 7 in the DDD mode to 78 +/- 9 beats/min in the DDDR mode significantly (p < 0.05). DDDR pacing did not result in an increased number of atrial salvos (2.6 atrial events/24 h) when compared to DDD pacing (2.5 atrial events/24 h, N.S.). These objective results were confirmed by the quality-of life assessment due to a symptom questionnaire. The symptom score declined from 20 +/- 10 in the DDD mode to 16 +/- 7 in the DDDR mode (p < 0.01). In the patients with chronotropic competence, however, cardiopulmonary exercise capacity did not improve in the DDDR mode: maximum heart rate was 120 +/- 21 versus 130 +/- 24 beats/min (N.S.), maximum oxygen uptake 17.7 +/- 5.9 versus 16.8 +/- 5.9 ml/kg/min (N.S.), The VO2/WR-ratio 9.8 +/- 2.3 versus 9.2 +/- 2.5 ml/min/watts (N.S.) and the exercise duration 407 +/- 159 versus 406 +/- 165 s (N.S.). The average maximum heart rate was 80 +/- 15 in the DDD mode and 83 +/- 16 beats/min in the DDDR mode (N.S.). Significantly more atrial arrhythmias occurred in the DDDR pacing mode: 1.6 atrial salvos per 24 h in the DDD mode versus 4.8 atrial salvos per 24 h in the DDDR mode (p < 0.05). This patient subgroup experienced a significant worsening of his quality-of-life. The symptom score rose from 20 +/- 9 in the DDD mode to 28 +/- 11 in the DDDR mode (p < 0.05). In conclusion, DDDR pacing improved cardiopulmonary exercise capacity, normalized heart rate variation over 24 h and increased quality-of-life in patients with chronotropic incompetence. On the contrary, since the DDDR pacing more could not improve cardiopulmonary exercise capacity, increased atrial arrhythmias and worsened the patient's quality-of-life, patients with chronotropic competence should not be programmed in the DDDR pacing mode.
本研究旨在评估基于加速度计的频率适应性双腔起搏期间的心肺运动能力、日常活动中心率的变化、房性心律失常的发生率及生活质量。9例频率适应性差和14例频率适应性好的患者（平均年龄51岁）被随机分配至DDD和DDDR模式，并通过超过无氧阈值的半卧位自行车运动试验、24小时动态心电图监测及生活质量问卷进行评估。在频率适应性差的患者亚组中，以心率/摄氧量比值（HR/VO2）定义，在DDDR起搏期间HR/VO2＜2次/毫升/千克，与DDD模式相比，最大心率从83±13次/分钟增加至132±7次/分钟（p＜0.01），最大摄氧量从12.7±3.1毫升/千克/分钟增加至15.3±3.2毫升/千克/分钟（p＜0.05），VO2/WR比值从8.1±1.0毫升/分钟/瓦特增加至9.0±0.9毫升/分钟/瓦特（p＜0.05）。运动持续时间从252±59秒延长至301±96秒（p＜0.05）。在24小时动态心电图记录期间，平均最大心率从DDD模式下的69±7次/分钟显著升至DDDR模式下的78±9次/分钟（p＜0.05）。与DDD起搏（2.5次房性事件/24小时）相比，DDDR起搏并未导致房性逸搏次数增加（2.6次房性事件/24小时，无统计学差异）。生活质量评估通过症状问卷证实了这些客观结果。症状评分从DDD模式下的20±10降至DDDR模式下的16±7（p＜0.01）。然而，在频率适应性好的患者中，DDDR模式下心肺运动能力并未改善：最大心率为120±21次/分钟对比130±24次/分钟（无统计学差异），最大摄氧量为17.7±5.9毫升/千克/分钟对比16.8±5.9毫升/千克/分钟（无统计学差异），VO2/WR比值为9.8±2.3毫升/分钟/瓦特对比9.2±2.5毫升/分钟/瓦特（无统计学差异），运动持续时间为407±159秒对比406±165秒（无统计学差异）。DDD模式下平均最大心率为80±15次/分钟，DDDR模式下为83±16次/分钟（无统计学差异）。DDDR起搏模式下发生的房性心律失常明显更多：DDD模式下每24小时1.6次房性逸搏，DDDR模式下每24小时4.8次房性逸搏（p＜0.05）。该患者亚组的生活质量显著恶化。症状评分从DDD模式下的20±9升至DDDR模式下的28±11（p＜0.05）。总之，DDDR起搏改善了频率适应性差患者的心肺运动能力，使24小时内心率变化正常化并提高了生活质量。相反，由于DDDR起搏不能改善频率适应性好患者的心肺运动能力，增加房性心律失常并恶化患者生活质量，频率适应性好的患者不应设置为DDDR起搏模式。
