Closed loop stimulation is effective in improving heart rate and blood pressure response to mental stress: Report of a single-chamber pacemaker study in patients with chronotropic incompetent atrial fibrillation

Riccardo Proietti, Gianmauro Manzoni, Luigi Di Biase, Gianluca Castelnuovo, Leonida Lombardi, Camilla Fundarò, Nadia Vegliante, Giada Pietrabissa, Pasquale Santangeli, Robert A. Canby, Antonio Sagone, Maurizio Viecca, Andrea Natale

Research output: Contribution to journalArticle

14 Citations (Scopus)

Abstract

Introduction: Closed-loop stimulation (CLS) is a form of rate-adaptive pacing capable of providing an effective pacing rate profile not only during physical exercise but also during mental stress. To test its effectiveness, CLS and accelerometer sensor (AS) rate response were compared intraindividually during a mental stress test (MST). Methods: Thirty-six patients (mean age 78.9 ± 6.4 years) implanted with a pacemaker with the CLS algorithm (Cylos, Biotronik, Berlin, Germany) underwent MSTs in different pacing configurations: nonrate-adaptive mode (VVI), AS mode (VVIR), and CLS mode, respectively. A modified Stroop test was used in order to induce mental stress. Heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure, and pacing percentage burden were collected for 5 minutes before, during, and 5 minutes after the test. Results: Mean peak-HR during MST was significantly higher in CLS configuration than in VVIR and VVI modes (92.8 ± 12.6 vs 78.9 ± 6.5 vs 77.8 ± 7.5; P ≤ 0.001). The average HR increase during MST was also higher in CLS configuration than in VVIR and VVI modes (22.7 ± 16.7 vs 8.2 ± 8.6 vs 6.6 ± 6.3; P ≤ 0.001). The percentage of pacing beats during MST was higher in CLS configuration than with the other two algorithms (48.4 ± 17.9 vs 27.4 ± 17.5 vs 25.8 ± 17.6; P ≤ 0.001). The average peak-SBP was significantly higher during MST in CLS mode than in VVIR and VVI configurations (172.6 ± 15.5 vs 156.7 ± 12.2 vs 145.5 ± 13.7; P ≤ 0.001). The mean SBP increase showed a similar behavior (51.8 ± 24.7 vs 18.4 ± 13.7 vs 16.4 ± 10.3; P ≤ 0.001). Conclusion: CLS algorithm in a single-chamber device is more effective than AS in detecting an hemodynamic demand due to an emotional stress and supplying a proper HR increase. These results are even more surprising compared to previous data in dual-chamber pacemakers, because they imply that CLS algorithm can provide an appropriate rate-modulation in patients with AF and chronotropic incompetence. (PACE 2012; 35:990-998)

Original languageEnglish (US)
Pages (from-to)990-998
Number of pages9
JournalPACE - Pacing and Clinical Electrophysiology
Volume35
Issue number8
DOIs
StatePublished - Aug 2012
Externally publishedYes

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Atrial Fibrillation
Heart Rate
Intelligence Tests
Blood Pressure
Exercise Test
Stroop Test
Berlin
Psychological Stress
Germany
Hemodynamics
Exercise
Equipment and Supplies

Keywords

  • atrial fibrillation
  • chronotropic incompetence
  • closed-loop stimulation
  • mental stress

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Closed loop stimulation is effective in improving heart rate and blood pressure response to mental stress : Report of a single-chamber pacemaker study in patients with chronotropic incompetent atrial fibrillation. / Proietti, Riccardo; Manzoni, Gianmauro; Di Biase, Luigi; Castelnuovo, Gianluca; Lombardi, Leonida; Fundarò, Camilla; Vegliante, Nadia; Pietrabissa, Giada; Santangeli, Pasquale; Canby, Robert A.; Sagone, Antonio; Viecca, Maurizio; Natale, Andrea.

In: PACE - Pacing and Clinical Electrophysiology, Vol. 35, No. 8, 08.2012, p. 990-998.

Research output: Contribution to journalArticle

Proietti, Riccardo ; Manzoni, Gianmauro ; Di Biase, Luigi ; Castelnuovo, Gianluca ; Lombardi, Leonida ; Fundarò, Camilla ; Vegliante, Nadia ; Pietrabissa, Giada ; Santangeli, Pasquale ; Canby, Robert A. ; Sagone, Antonio ; Viecca, Maurizio ; Natale, Andrea. / Closed loop stimulation is effective in improving heart rate and blood pressure response to mental stress : Report of a single-chamber pacemaker study in patients with chronotropic incompetent atrial fibrillation. In: PACE - Pacing and Clinical Electrophysiology. 2012 ; Vol. 35, No. 8. pp. 990-998.
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T1 - Closed loop stimulation is effective in improving heart rate and blood pressure response to mental stress

T2 - Report of a single-chamber pacemaker study in patients with chronotropic incompetent atrial fibrillation

AU - Proietti, Riccardo

AU - Manzoni, Gianmauro

AU - Di Biase, Luigi

AU - Castelnuovo, Gianluca

AU - Lombardi, Leonida

AU - Fundarò, Camilla

AU - Vegliante, Nadia

AU - Pietrabissa, Giada

AU - Santangeli, Pasquale

AU - Canby, Robert A.

AU - Sagone, Antonio

AU - Viecca, Maurizio

AU - Natale, Andrea

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N2 - Introduction: Closed-loop stimulation (CLS) is a form of rate-adaptive pacing capable of providing an effective pacing rate profile not only during physical exercise but also during mental stress. To test its effectiveness, CLS and accelerometer sensor (AS) rate response were compared intraindividually during a mental stress test (MST). Methods: Thirty-six patients (mean age 78.9 ± 6.4 years) implanted with a pacemaker with the CLS algorithm (Cylos, Biotronik, Berlin, Germany) underwent MSTs in different pacing configurations: nonrate-adaptive mode (VVI), AS mode (VVIR), and CLS mode, respectively. A modified Stroop test was used in order to induce mental stress. Heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure, and pacing percentage burden were collected for 5 minutes before, during, and 5 minutes after the test. Results: Mean peak-HR during MST was significantly higher in CLS configuration than in VVIR and VVI modes (92.8 ± 12.6 vs 78.9 ± 6.5 vs 77.8 ± 7.5; P ≤ 0.001). The average HR increase during MST was also higher in CLS configuration than in VVIR and VVI modes (22.7 ± 16.7 vs 8.2 ± 8.6 vs 6.6 ± 6.3; P ≤ 0.001). The percentage of pacing beats during MST was higher in CLS configuration than with the other two algorithms (48.4 ± 17.9 vs 27.4 ± 17.5 vs 25.8 ± 17.6; P ≤ 0.001). The average peak-SBP was significantly higher during MST in CLS mode than in VVIR and VVI configurations (172.6 ± 15.5 vs 156.7 ± 12.2 vs 145.5 ± 13.7; P ≤ 0.001). The mean SBP increase showed a similar behavior (51.8 ± 24.7 vs 18.4 ± 13.7 vs 16.4 ± 10.3; P ≤ 0.001). Conclusion: CLS algorithm in a single-chamber device is more effective than AS in detecting an hemodynamic demand due to an emotional stress and supplying a proper HR increase. These results are even more surprising compared to previous data in dual-chamber pacemakers, because they imply that CLS algorithm can provide an appropriate rate-modulation in patients with AF and chronotropic incompetence. (PACE 2012; 35:990-998)

AB - Introduction: Closed-loop stimulation (CLS) is a form of rate-adaptive pacing capable of providing an effective pacing rate profile not only during physical exercise but also during mental stress. To test its effectiveness, CLS and accelerometer sensor (AS) rate response were compared intraindividually during a mental stress test (MST). Methods: Thirty-six patients (mean age 78.9 ± 6.4 years) implanted with a pacemaker with the CLS algorithm (Cylos, Biotronik, Berlin, Germany) underwent MSTs in different pacing configurations: nonrate-adaptive mode (VVI), AS mode (VVIR), and CLS mode, respectively. A modified Stroop test was used in order to induce mental stress. Heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure, and pacing percentage burden were collected for 5 minutes before, during, and 5 minutes after the test. Results: Mean peak-HR during MST was significantly higher in CLS configuration than in VVIR and VVI modes (92.8 ± 12.6 vs 78.9 ± 6.5 vs 77.8 ± 7.5; P ≤ 0.001). The average HR increase during MST was also higher in CLS configuration than in VVIR and VVI modes (22.7 ± 16.7 vs 8.2 ± 8.6 vs 6.6 ± 6.3; P ≤ 0.001). The percentage of pacing beats during MST was higher in CLS configuration than with the other two algorithms (48.4 ± 17.9 vs 27.4 ± 17.5 vs 25.8 ± 17.6; P ≤ 0.001). The average peak-SBP was significantly higher during MST in CLS mode than in VVIR and VVI configurations (172.6 ± 15.5 vs 156.7 ± 12.2 vs 145.5 ± 13.7; P ≤ 0.001). The mean SBP increase showed a similar behavior (51.8 ± 24.7 vs 18.4 ± 13.7 vs 16.4 ± 10.3; P ≤ 0.001). Conclusion: CLS algorithm in a single-chamber device is more effective than AS in detecting an hemodynamic demand due to an emotional stress and supplying a proper HR increase. These results are even more surprising compared to previous data in dual-chamber pacemakers, because they imply that CLS algorithm can provide an appropriate rate-modulation in patients with AF and chronotropic incompetence. (PACE 2012; 35:990-998)

KW - atrial fibrillation

KW - chronotropic incompetence

KW - closed-loop stimulation

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