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Rate Responsive Pacemakers: A Rapid Assessment Protocol
Author(s) -
SHABER JUSTIN D.,
FISHER JOHN D.,
RAMACHANDRA INDIRESHA,
GONZALEZ CHRISTIAN,
ROSENBERG LAUREN,
FERRICK KEVIN J.,
GROSS JAY N.,
KIM SOO G.
Publication year - 2008
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.1540-8159.2007.00968.x
Subject(s) - medicine , treadmill , heart rate , exertion , rating of perceived exertion , cardiology , bruce protocol , physical therapy , blood pressure
Background:Rate responsive (RR) pacemakers are commonly implanted with nominal conservative factory‐set responsiveness, which is usually accepted because established exercise protocols are time‐consuming. We aimed for efficient assessment of RR pacemaker settings.Methods:We tested exercise heart rates in controls and paced patients using a brief exercise test that approximates real‐life levels of exertion. The test used a nonmotorized treadmill: 30 seconds walking at patient‐determined speed followed by 15 seconds brisk exertion. Subjects totaled 110: 26 with RR pacemakers; 22 with non‐RR pacers; 27 “sick” nonpaced control patients; and 35 healthy controls. Heart rate (HR) was measured prior to exercise, after 30 seconds of casual walk, after 15 seconds of brisk walk, and 1 minute into recovery. Testing required <5 minutes from set‐up to recovery.Results:The 26 RR pacer patients had a mean HR at rest = 74 ± 10 beats per minute (bpm), walk = 87 ± 14, and brisk = 94 ± 18 (increase 27%). Non‐RR pacer patients (n = 22): rest = 73 ± 12 bpm, walk = 88 ± 14, and brisk = 94 ± 17 (increase 24.3%, P = 0.60 vs RR patients). “Sick” controls (n = 27): rest = 78 ± 14 bpm, walk = 102 ± 17, and brisk = 117 ± 18 (increase 51.9%, P< 0.001 vs RR pts). For the healthy controls, HRs were at rest 83+/11 bpm, walk = 104 ± 12, and brisk = 117 ± 13 (P< 0.001 compared to both paced groups; P = NS vs sick controls).Conclusions:Nominal RR settings may be suboptimal for many patients. The nonmotorized treadmill test allows quick and inexpensive assessment of RR programming, with the potential for efficient RR optimization.