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
Article first published online: 9 JUN 2012
©2012, The Authors. Journal compilation ©2012 Wiley Periodicals, Inc.
Pacing and Clinical Electrophysiology
Volume 35, Issue 8, pages 990–998, August 2012
How to Cite
PROIETTI, R., MANZONI, G., DI BIASE, L., CASTELNUOVO, G., LOMBARDI, L., FUNDARÒ, C., VEGLIANTE, N., PIETRABISSA, G., SANTANGELI, P., CANBY, R. A., SAGONE, A., VIECCA, M. and NATALE, A. (2012), 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. Pacing and Clinical Electrophysiology, 35: 990–998. doi: 10.1111/j.1540-8159.2012.03445.x
No conflicts of interest.
- Issue published online: 6 AUG 2012
- Article first published online: 9 JUN 2012
- Received October 3, 2011; revised April 8, 2012; accepted April 11, 2012.
Vol. 37, Issue 10, 1421, Article first published online: 18 OCT 2012
- closed-loop stimulation;
- mental stress;
- chronotropic incompetence;
- atrial fibrillation
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)