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Respiratory‐Dependent Atrial Pacing, Management of Sinus Node Disease
Author(s) -
ROGI G.,
BOLOGNESE L.,
AINA F.,
OCGHETTA E.,
MAGNANI A.,
ROSSI P.
Publication year - 1988
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 - 10.1111/j.1540-8159.1988.tb06320.x
Subject(s) - medicine , anaerobic exercise , heart rate , cardiology , respiratory rate , treadmill , respiratory exchange ratio , respiratory system , anesthesia , physical therapy , blood pressure
The effectiveness of respiratory‐dependent atrial pacing (AAI‐RD) was assessed in 23 patients (11 male, 12 female; 68 ± 10 years) with symptomatic isolated sinus node disease (SND). Follow‐up was performed at 3 month intervals and included history taking, physical examination, ECG recording and 24‐hour Holter monitoring. An incremental treadmill exercise test was performed in 21/23 patients before pacemaker implantation, in 23/23 patients after implantation (at least two tests with different programmed settings of respiratory rate/paced rate ratio); 21/23 patients underwent treadmill tests during both fixed rate 70 bpm and AAI‐RD pacing. Physiological sensitivity of AAI‐RD pacing was found excellent in 34 tests (85%) and fair in six (15%). Spontaneous heart rate was significantly higher after pacemaker implantation fbpm 115 ± 20 vs 98 ± 24, P < 0.001). In 10/21 patients paced rate was significantly higher during AAI‐RD vs AAI pacing (131 ±9 vs 106 ± 16, P < 0.001) with better total work time (min 9.9 ± 4 AAI‐RD vs 6.8 ± 2.6 AAI, P < 0.002), higher oxygen consumption at anaerobic threshold (ml/min 1137 ± 406 AAI‐RD vs 882 ± 268 AAI‐RD vs 5.5 ± 2.6 AAI, P ‐ 0.001). No significant difference was found in 7/21 patients (overlap between spontaneous and paced rate during both AAI‐RD and AAI programming); 4/21 patients did not reach anaerobic threshold owing to osteomuscular limitations. AV block was detected in 1/23 patients, Biorate circuital failure in 1/23, sporadic undersensing in 5/23, short and symptom‐free myopotential inhibitions in 10/23. We concluded that AAI‐RD pacing is a reliable, safe and useful modality in pacemaker management of isolated SNA, especially in patients with abnormal rate response to exercise.