Cardiopulmonary Exercise Testing in Rate-Modulated Cardiac Pacing Based on Minute Ventilation and QT-Interval

  • Franz van Erckelens
  • M. Sigmund
  • Ch. Reupcke
  • B. Heiermann
  • P. Hanrath
Conference paper

Abstract

In pacemaker patients, both atrio-ventricular (AV)-synchronity and an appropriate rate response to exercise are desirable. Given primary atrial arrhythmias or an abnormal sinoatrial conduction, atrial tracking devices (VDD or DDD) cannot be utilized for adequate rate-adaptive pacing. Therefore, the development of pacemaker devices that provide exercise-related rate-adaption independent of atrial function has gained special interest [23]. Several sensors have been tested for rate-responsive pacing as for their suitability to effect an exercise-induced increase of stimulation rate [1, 4, 10, 12, 14, 18, 19, 23, 25, 28, 40].

Keywords

Dioxide Lactate Respiration Catecholamine Cardiol 

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References

  1. 1.
    Alt E, Heinz M, Hirgstetter C (1987) Control of pacemaker rate by impedance based on respiratory minute ventilation. Chest 92: 247PubMedCrossRefGoogle Scholar
  2. 2.
    Alt E, Völker R, Högl B, McCarter D (1988) Kardiopulmonale Belastungstests unter frequenzvariabler Stimulation: Ein Vergleich von Nova MR Schrittmachern zu VVI-/AAI-Stimulation. Z Kardiol 77: 456Google Scholar
  3. 3.
    Ausubel K, Steingart RM, Shishmi M; Klementowicz P, Furman S (1985) Maintenance of exercise stroke volume during ventricular versus atrial synchronous pacing. Circulation 72: 1037PubMedCrossRefGoogle Scholar
  4. 4.
    Benditt DG, Mianulli M, Fetter J, Benson DW, Dunnigan A, Molina E, Gornick CC, Almquist A (1987) Single-chamber cardiac activity-initiated chronotropic response: evaluation by cardiopulmonary exercise testing. Circulation 75: 184PubMedCrossRefGoogle Scholar
  5. 5.
    Browne KF, Prystowsky E, Heger JJ, Zipes DP (1983) Modulation of the QT interval by the autonomic nervous system. PACE 6/II: 1050Google Scholar
  6. 6.
    Dickstein K, Barvik S, Aarsland T, Snappin S, Karlsson J (1990) A comparison of methodologies in detection of the anaerobic threshold. Circulation 81: III - 38Google Scholar
  7. 7.
    Donaldson RM, Rickards AF (1982) Evaluation of drug-induced changes in myocardial repolarisation using the paced evoked response. Br Heart J 48: 381PubMedCrossRefGoogle Scholar
  8. 8.
    Donaldson RM, Rickards AF (1983) Rate responsive pacing using the evoked QT principle. A physiological alternative to atrial synchronous pacemakers. PACE 5: 1344Google Scholar
  9. 9.
    Fananapazier L, Bennet DH, Monks P (1983) Atrial synchronized ventricular pacing: contribution of the chronotropic response to improved exercise performance. PACE 6: 601Google Scholar
  10. 10.
    Foerestrand S (1989) Comparison among different biosensors. 4th Europ Symp Cardiac Pacing 79Google Scholar
  11. 11.
    Fujiki A, Tani M, Mizumaki K, Asoni H, Sasayama S (1990) Pacemaker syndrome evaluated by cardiopulmonary exercise testing. PACE 13: 1236PubMedGoogle Scholar
  12. 12.
    Gilette P (1984) Critical analysis of sensors for physiological responsive pacing. PACE 4: 1263Google Scholar
  13. 13.
    Hedman A, Nordlander R, Kenneth Pehrsson S, Astrom H (1986) Clinical experience with rate responsive pacing by the evoked QT. Stimucoeur 14: 22Google Scholar
  14. 14.
    Hedman A, Nordlander R (1988) Changes in QT and Q-aT intervals induced by mental and physical stress with fixed rate and atrial triggered ventricular inhibited cardiac pacing. PACE 11: 1426PubMedGoogle Scholar
  15. 15.
    Hedmann A, Nordlander R (1988) QT-sensing rate responsive pacing versus fixed-rate ventricular pacing. A controlled clinical study. PACE 11: 506Google Scholar
  16. 16.
    Jordaens L, Bergmans L, van Wasserhove E, Clement DL (1989) Behaviour of a respiratory driven pacemaker and direct respiratory measurements. PACE 12: 1600PubMedGoogle Scholar
  17. 17.
    Kay GN, Bubien RS, Epstein AE, Plumb VJ (1989) Rate-modulated cardiac pacing based on transthoracid impedance measurements of minute ventilation: correlation with exercise gas exchange. J Am Coll Cardiol 14: 1283PubMedCrossRefGoogle Scholar
  18. 18.
    Lau CP, Leigh-Jones M, Kingwell S (1988) Comparative evaluation of two respiratory sensing rate responsive pacemakers PACE 11: 487Google Scholar
  19. 19.
    Maisch B, Langenfeld H (1986) Rate adaptive pacing — clinical experience with three different pacing systems. PACE 9: 997PubMedGoogle Scholar
  20. 20.
    McElroy P, Janicki JS, Weber KT (1988) Physiologic correlates of the heart rate response to upright isotonic exercise: relevance to rate-responsive pacemakers. J Am Coll Cardiol 11: 94PubMedCrossRefGoogle Scholar
  21. 21.
    Myers J, Buchanan N, Shimizu M, Walsh D, Kraewmer M, McAuley P, Froehlicher V (1990) The ventilatory threshold (ATge) Method, protocol and evaluator agreement. Circulation 82: III - 240CrossRefGoogle Scholar
  22. 22.
    Milne JR, Ward DE, Spurell RAJ, Camm AJ (1982) The ventricular paced QT interval — The effect of rate and exercise. PACE 5: 352PubMedGoogle Scholar
  23. 23.
    Mond HG (1989) Rate responsive cardiac pacing — A perspective. PACE 12: 1309PubMedGoogle Scholar
  24. 24.
    Neuberg GW (1990) Cardiopulmonary exercise testing. Chest 97–2: 257Google Scholar
  25. 25.
    Rickards AF, Norman J (1981) Relation between QT interval and heart rate — New design of physiologically adaptive cardiac pacemaker. Br Heart J 43: 56CrossRefGoogle Scholar
  26. 26.
    Rickards AF, Donaldson RM, Thalen AM (1983) The use of QT interval to determine pacing rate: early clinical experience. PACE 10: 650Google Scholar
  27. 27.
    Rickards AF (1986) Rate responsive pacing using QT sensing. Clin Progr Electrophysiol and Pacing 4: 7Google Scholar
  28. 28.
    Rossi P, Plicchi G, Canducci G (1984) Respiration as a reliable physiological sensor for controlling cardiac pacing rate. Br Heart J 51: 7PubMedCrossRefGoogle Scholar
  29. 29.
    Rouwen T, Krulls J, Wagner J (1986) Sensitivity of the Stim-T time to different workloads. Clin Prog Electrophysiol Pacing 4: 9Google Scholar
  30. 30.
    Sigmund M, Uebis R, Recker S, Eifert S (1987) Frequency adaptation of QT controlled pacemakers. Pacing and Clinical Electrophysiology 10: 742Google Scholar
  31. 31.
    Sullivan M, Cobb F (1990) The anaerobic threshold in chronic heart failure. Circulation 81: III - 47CrossRefGoogle Scholar
  32. 32.
    Treese N, Coutinho M, Stegmaier A, Meyer J (1990) Optimierung frequenzvariabler Schrittmachersysteme durch Spiroergometrie. Herzschr Elektrophysiol 1: 13Google Scholar
  33. 33.
    Treese N, Coutinho M, Ophoff N, Rhein S, Pop T, Meyer J (1990) Kardiopulmonale Belastung: Funktionskontrolle fur frequenzvariable Schrittmachersysteme. Z Kardiol 79: 396Google Scholar
  34. 34.
    Vai F, Bonnet JL, Ritter Ph, Pioger G (1988) Relationship between heart rate and minute ventilation, tidal volume and respiratory rate during brief and low level exercise. PACE 11: 1860PubMedGoogle Scholar
  35. 35.
    Van Erckelens F, Sigmund M, Firnich G, Speckamp F, Pesches U, Hanrath P (1990) Belastungsinduzierte Frequenzantwort unter QT-gesteuerter Stimulation: automatische Slope-Einstellung versus individuelle Programmierung. Z f Kardiol 79: 54Google Scholar
  36. 36.
    Wasserman K (1987) Determinants and detection of anaerobic threshold and consequences of exercise about it. Circulation 76, VI: 29Google Scholar
  37. 37.
    Wasserman K, Hansen JE, Sue DY, Whipp BJ (1987) Principles of exercise testing and interpretation. Philadelphia. Lea and FebigerGoogle Scholar
  38. 38.
    Wasserman K, Beaver WL, Whip BJ (1990) Gas exchange theory and the lactic acidosis (anaerobic) threshold. Circulation 81: II - 16Google Scholar
  39. 39.
    Weber KT, Janicki JS (1986) Cardiopulmonary exercise testing. Philadelphia. WB SaundersGoogle Scholar
  40. 40.
    Wirtzfeld A, Stangl K, Maubach P (1989) Biological sensors: different types and combinations. 4th Europ Symp cardiac Pacing 15Google Scholar

Copyright information

© Dr. Dietrich Steinkopff Verlag GmbH & Co. KG, Darmstadt 1991

Authors and Affiliations

  • Franz van Erckelens
    • 1
  • M. Sigmund
    • 1
  • Ch. Reupcke
    • 1
  • B. Heiermann
    • 1
  • P. Hanrath
    • 1
  1. 1.Medical Clinic IRWTH AachenAachenGermany

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