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Clinical Performance of Automatic Closed‐Loop Stimulation Systems
Author(s) -
GRIESBACH LOTHAR,
GESTRICH BRIGITTA,
WOJCIECHOWSKI DARIUSZ,
WEYERS GEORG,
TÖNGES JÜRGEN,
SCHIER MATTHIAS,
DANILOVIC DEJAN
Publication year - 2003
Publication title -
pacing and clinical electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.686
H-Index - 101
eISSN - 1540-8159
pISSN - 0147-8389
DOI - 10.1046/j.1460-9592.2003.t01-1-00207.x
Subject(s) - medicine , stairs , heart rate , cardiology , cls upper limits , nocturnal , circadian rhythm , blood pressure , ophthalmology , civil engineering , engineering
Inos pacemakers use contraction dynamics to regulate the pacing rate according to the Closed‐Loop Stimulation (CLS) principle. The physician can program only the lower and upper rate limits, while the internal rate responsive parameters are continually adjusted to changing patient conditions. Seventy‐two patients with sinus node disease were enrolled in the multicenter Rate Behavior of the Pacing System Inos 2 CLS during Daily Life (RAPID) study to evaluate the appropriateness of CLS rates during daily activities and the long‐term stability of the system. The pacemakers clearly differentiated between climbing stairs, descending stairs, and slow walking, with the corresponding peak rates of104 ± 18, 95 ± 15, and88 ± 11 beats/min, respectively (P < 0.001for any pair of activities). The peak CLS rate during the color‐word test was significantly higher than that at rest (80 ± 8vs67 ± 7 beats/min, P = 0.002). The 24‐hour heart rate trends retrieved from the pacemaker memory at 3, 6, and 12 months after implantation appeared appropriate in all patients except for two whose pacing rates were occasionally too fast during the night. Mean diurnal and nocturnal rates determined at 3‐month, 6‐month, and 12‐month examinations fluctuated only slightly, from 74.6–75.3 beats/min (diurnal,P = NS) and from 67.0–68.1 beats/min (nocturnal,P = NS), indicating a satisfactory long‐term stability of the system. The incidence of atrial pacing events during the entire follow‐up was82 ± 18%. A 6.5–8.3 beats/min difference, on average, between day and night(P < 0.001)and distinction between different daily activities seem to evidence sensitivity of the automatic CLS‐driven pacemakers to physiological demands despite minimum programming requirements. (PACE 2003; 26[Pt. I]:1432–1437)