Rate Response of a Closed-Loop Stimulation Pacing System to Changing Preload and Afterload Conditions

Autor:	Stefan Osswald, Thomas A. Cron, Dagmar I. Keller, Hartmut Schächinger, Christos D. Pouskoulas, Christian Zaugg, Matthias Pfisterer, Peter Buser, Patrick Hilti
Rok vydání:	2003
Předmět:	Male Tachycardia Pacemaker Artificial medicine.medical_specialty Blood Pressure Blood volume Autonomic Nervous System Contractility Tilt table test Afterload Heart Rate Tilt-Table Test Internal medicine Heart rate medicine Humans Aged Aged 80 and over Hand Strength medicine.diagnostic_test business.industry Cardiac Pacing Artificial Heart General Medicine Middle Aged Myocardial Contraction Preload Blood pressure Anesthesia Ventricular Function Right cardiovascular system Cardiology Female medicine.symptom Cardiology and Cardiovascular Medicine business
Zdroj:	Pacing and Clinical Electrophysiology. 26:1504-1510
ISSN:	1540-8159 0147-8389
Popis:	Closed-loop stimulation (CLS) is a new sensor concept for rate adaptive pacing measuring changes in the unipolar right ventricular impedance, which correlates to changes of the right ventricular contractility and reflects the autonomic nervous innervation of the heart. Some patients do not tolerate the CLS mode because of inappropriate tachycardia, mainly related to postural changes. This study tested if the rate response of the CLS sensor is influenced not only by myocardial contractility but also by rapid changes in right ventricular filling. In 12 patients (10 men, median age 77 years) with a Biotronik Inos(2)-CLS DDDR pacemaker and 14 controls (13 men, median age 59 years) head-up tilt and handgrip testing was performed to provoke rapid changes in pre- and afterload. Tilting the pacemaker patients resulted in a nonphysiological steep increase of the sensor rate (increase >20 beats/min, peak after 1 minute, return to baseline within 2-3 minutes), which was significantly different from the control group, showing only a slight rise in intrinsic heart rate immediately after tilting. Simultaneously to the rapid increase in sensor rate, the pacemaker patients showed a marked orthostatic decline of systolic blood pressure. During handgripping, heart rate and blood pressure curves were similar in both groups. In patients with this CLS pacemaker, rapid preload reduction during head-up tilting caused an overshooting sensor rate increase, reproducing the authors' clinical observation of postural pacemaker tachycardia in some patients. Consequently, they concluded that the rate response of the CLS pacing system can be inappropriately influenced by rapid shifts of blood volume, affecting right ventricular filling.
Databáze:	OpenAIRE
Externí odkaz:	https://explore.openaire.eu/search/publication?articleId=doi_dedup___::af3e2e47446f4125a28399dd56830047 https://doi.org/10.1046/j.1460-9592.2003.t01-1-00218.x Zobrazit plný text záznamu Plný text ve formátu PDF Plný text ve formátu HTML
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