Key result
Reprogramming pacemakers to DDDR increases VO2 max by ~13% compared to VVI.
Why the study?
While pacemaker programming mode correlates with exercise capacity over long-term follow-up, whether reprogramming can produce immediate effects on exercise capacity remained untested.
Does dual chamber pacing with an exercise adaptable rate improve exercise capacity compared to single-chamber fixed-rate pacing in patients with dual-chamber pacemakers?
Does dual chamber pacing with an exercise adaptable rate improve exercise capacity compared to single-chamber fixed-rate pacing in patients with dual-chamber pacemakers?
Absolute Event Rate: 14.52% vs 12.82%
p-value: p=0.02
Reprogramming dual-chamber pacemakers to a rate-adaptive mode immediately improves exercise capacity compared to fixed-rate single-chamber pacing.
May improve exercise capacity in dual-chamber pacemaker patients; leaves open need for randomized confirmation before practice change.
Background: Previous studies have demonstrated a direct correlation between pacemaker programming mode and exercise capacity on a long-term follow-up. In the present study we aimed to test whether reprogramming of the pacemaker can produce immediate effects on patients' exercise capacity. Methods: The exercise capacity of 33 patients wearing dual-chamber pacemakers was evaluated by cardiopulmonary exercise test at 24-hour intervals in two programming modes: initially in the single-chamber ventricular pacing mode with a fixed 60bpm rate, and in the second phase in dual chamber pacing mode with exercise adaptable rate, up to 130bpm. Results: The maximum O2 consumption (VO2 max: 12.82±2.70 mL/kg/min vs 14.52±3.25 mL/kg/min, p=0.02), the O2 consumption at the time of the anaerobic threshold (10.76±2.25 mL/kg/min vs 12.30±2.84 mL/kg/min, p=0.008), the duration of exercise (456.76±116.85 seconds vs 510.57±129.56 seconds, p=0.04) and the maximum workload (84.39±17.89W vs 96.36±24.09W, p=0.01) were significantly lower when the pacemakers were programmed in the single chamber ventricular fixed-rate pacing mode compared to the dual chamber rate adaptive pacing mode. Conclusion: Cardiac pacemaker reprogramming is able to exert immediate effects on exercise capacity. Dual chamber pacing with adaptable rate during physical exercise is superior to single chamber fixed rate pacing
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Caloian et al. (2023) studied Sick sinus syndrome (n=33). Dual chamber pacing mode with exercise adaptable rate (DDDR) vs. Single-chamber ventricular pacing mode with fixed 60bpm rate (VVI) was evaluated on Maximum O2 consumption (VO2 max) (p=0.02). Reprogramming pacemakers to a dual-chamber rate-adaptive mode (DDDR) significantly increased maximum oxygen consumption compared to a single-chamber fixed-rate mode (VVI) (14.52 vs 12.82 mL/kg/min, p=0.02).
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