Rate responsive pacemakers: A rapid assessment protocol

Justin D. Shaber, John Devens Fisher, Indiresha Ramachandra, Christian Gonzalez, Lauren Rosenberg, Kevin J. Ferrick, Jay N. Gross, Soo G. Kim

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)192-197
Number of pages6
JournalPACE - Pacing and Clinical Electrophysiology
Volume31
Issue number2
DOIs
StatePublished - Feb 2008

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Heart Rate
Exercise
Exercise Test
Walking

Keywords

  • Nonmotorized treadmill
  • Pacemaker
  • Rate modulated
  • Rate responsive

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Rate responsive pacemakers : A rapid assessment protocol. / Shaber, Justin D.; Fisher, John Devens; Ramachandra, Indiresha; Gonzalez, Christian; Rosenberg, Lauren; Ferrick, Kevin J.; Gross, Jay N.; Kim, Soo G.

In: PACE - Pacing and Clinical Electrophysiology, Vol. 31, No. 2, 02.2008, p. 192-197.

Research output: Contribution to journalArticle

Shaber, Justin D. ; Fisher, John Devens ; Ramachandra, Indiresha ; Gonzalez, Christian ; Rosenberg, Lauren ; Ferrick, Kevin J. ; Gross, Jay N. ; Kim, Soo G. / Rate responsive pacemakers : A rapid assessment protocol. In: PACE - Pacing and Clinical Electrophysiology. 2008 ; Vol. 31, No. 2. pp. 192-197.
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abstract = "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.",
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