What does this research mean for the field?

Closed-loop stimulation pacing mimics short-term physiological heart rate variability and reduces sympathetic predominance in spontaneous beats compared with fixed-rate DDD pacing. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

November 4, 2009Pacing and Clinical Electrophysiology

Autonomic Function during Closed Loop Stimulation and Fixed Rate Pacing: Heart Rate Variability Analysis from 24-Hour Holter Recordings

Q: What is the clinical evidence from this study?

Study design: RCT. Population: Patients implanted with a dual-chamber pacemaker (n=15). Intervention: Closed-loop stimulation (CLS) pacing mode vs. DDD pacing mode. Primary outcome: Heart rate variability (spectral parameters including total power, LF, HF, and LF/HF ratio).

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Key result

Closed-loop stimulation lowers LF/HF ratio of spontaneous beats versus DDD pacing, mimicking physiological HRV.

n=15

Why the study?

The effect of closed-loop stimulation (CLS) versus DDD pacing mode on autonomic balance and heart rate variability (HRV) in patients with dual-chamber pacemakers was not well characterized.

Does closed-loop stimulation (CLS) pacing mode improve autonomic balance compared to DDD pacing mode in patients with dual-chamber pacemakers?

Population

15 patients implanted with dual-chamber pacemaker (Inos(2+) CLS-Biotronik GmbH)

Comparison

Closed-loop stimulation (CLS) pacing mode vs DDD pacing mode

Design

Retrospective randomized crossover study with 24-hour Holter HRV analysis

Follow-up

3 months per pacing mode

Authors

RQRaffaele QuaglionePoliclinico Umberto I GCGiovanni CalcagniniElectrophysiology FCFederica CensiIstituto Superiore di Sanità

Discussion

Member takes

Implication

Hypothesis-generating for CLS over DDD in restoring HRV; prospective RCTs needed before any practice shift.

Study Design

Type

RCT (n=15)

Randomization

randomly assigned

Structured PICO

Does closed-loop stimulation (CLS) pacing mode improve autonomic balance compared to DDD pacing mode in patients with dual-chamber pacemakers?

Population

15 patients implanted with a dual-chamber pacemaker, evaluated with 24-hour Holter recordings after 3-month periods of CLS and DDD pacing.

Intervention

Closed-loop stimulation (CLS) pacing mode for 3 months

Comparator

DDD pacing mode for 3 months

Outcome

Autonomic balance estimated by 24-hour heart rate variability (HRV) analysis (total power, LF, HF, LF/HF ratio)surrogate

Closed-loop stimulation pacing mode appears to better preserve physiological heart rate variability and autonomic balance compared to fixed-rate DDD pacing.

Cite This Study

Quaglione et al. (2009) conducted an RCT in Patients implanted with a dual-chamber pacemaker (n=15). Closed-loop stimulation (CLS) pacing mode vs. DDD pacing mode was evaluated on Heart rate variability (spectral parameters including total power, LF, HF, and LF/HF ratio). Closed-loop stimulation pacing mode mimicked short-term physiological heart rate variability and resulted in a lower LF/HF ratio of spontaneous beats compared to DDD pacing mode.

synapsesocial.com/papers/6aaddf529cf7b8608e873d2a https://doi.org/10.1111/j.1540-8159.2009.02615.x

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Autonomic Function during Closed Loop Stimulation and Fixed Rate Pacing: Heart Rate Variability Analysis from 24-Hour Holter Recordings

Discussion

Member takes

Implication

Study Design

Structured PICO

Cite This Study

Autonomic Function during Closed Loop Stimulation and Fixed Rate Pacing: Heart Rate Variability Analysis from 24-Hour Holter Recordings

Discussion

Member takes

Implication

Study Design

Structured PICO

Cite This Study

Also Consider

Also Consider