Key result
ANS-controlled pacing using VIP closely correlates with spontaneous sinus rate during exercise in AV block.
Why the study?
Innovations in pacing technology aim to improve quality of life in sick sinus syndrome by restoring physiological closed-loop chronotropic control using autonomic nervous system signals.
Does closed-loop pacing using right ventricular conductance improve chronotropic control in patients with AV block?
Does closed-loop pacing using right ventricular conductance improve chronotropic control in patients with AV block?
Closed-loop pacing using right ventricular conductance to extract ANS control information provides pacing rates that closely correlate with spontaneous sinus rates during exercise.
Answers are grounded in this paper and cite their sources.
May enable closed-loop rate-adaptive pacing in sick sinus syndrome; leaves open prospective outcome validation.
Innovations in pacing technology, which include the addition of rate-responsive features to programmable pacemakers, can improve the quality of life of patients suffering from sick sinus syndrome. Among the strategies providing rate-adaptive cardiac pacing, the most attractive is the physiological restoration of closed-loop chronotropic control. This paper describes how autonomic nervous system (ANS) control information is extracted from dynamic measures of myocardial contractile performance obtained from unipolar conductance measurements using the stimulation electrode in the right ventricular cavity. The pacemaker uses the ANS information to modulate pacing rate and restore normal physiological control of heart rate. A new algorithm, regional effective slope quantity (RQ), for isolating the ANS signal was developed. The resulting signal, ventricular inotropic parameter (VIP), is a normalized parameter proportional to the strength of the ANS inotropic signals to the myocardium. The efficacy of the ANS control concept was evaluated in multi-centre studies. Patients with AV block and VIP-controlled pulse generators performed defined exercise protocols. The ANS-controlled pacing rate and the spontaneous sinus rate were closely correlated. Blood pressure and subjective patient reports further indicated that good control of the cardiovascular circulation was achieved.
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Schaldach et al. (1992) studied AV block. VIP-controlled pulse generators was evaluated on Correlation between ANS-controlled pacing rate and spontaneous sinus rate. ANS-controlled pacing using the ventricular inotropic parameter closely correlated with spontaneous sinus rate during exercise protocols in patients with AV block.
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