Key result
ANS-controlled pacemakers lack quantitative results for physiological heart rate control in chronotropic insufficiency.
Why the study?
Reestablishing closed loop cardiac control in patients with chronotropic insufficiency using sympathetic tone information from myocardial contractility was investigated.
Does autonomic nervous system controlled closed loop cardiac pacing provide appropriate physiological heart rate responses in patients with chronotropic insufficiency?
Observational (n=200)
Yes
Does autonomic nervous system controlled closed loop cardiac pacing provide appropriate physiological heart rate responses in patients with chronotropic insufficiency?
Autonomic nervous system-controlled closed-loop cardiac pacing using intracardiac impedance to derive sympathetic tone is proposed as a method to reestablish physiological heart rate control in chronotropic insufficiency.
Answers are grounded in this paper and cite their sources.
VIP-based closed-loop pacing may restore physiological rate response in chronotropic insufficiency; leaves open confirmation in randomized trials.
A multicenter clinical study is presented, which focuses on the reestablishment of closed loop cardiac control in patients with chronotropic insufficiency. Using the information about sympathetic tone contained in the myocardial contractility, it is possible to reconnect the heart rate to the physiological control mechanisms. Intracardiac impedance is measured with the ventricular electrode and the ventricular inotropic parameter (VIP) is derived from that. The VIP serves directly as input to the control of heart rate by the pacemaker. Over 200 patients have received autonomic nervous system (ANS) controlled pacemakers. The patient-pacemaker system was investigated in different ways. This included standard exercise tests, long-term studies of every day activities over 24 hours, psychological, and pharmacological challenges. To prove the validity of the approach we specifically looked at (1) the appropriateness of changes in paced heart rate with sympathetic tone during exercise, (2) the correlation between heart rate and sinus rate, if detectable, and (3) the correlation between the echocardiographically determined preejection period (PEP) and the VIP controlled heart rate.
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Pichlmaier et al. (1992) conducted an observational in Chronotropic insufficiency (n=200). Autonomic nervous system (ANS) controlled pacemakers was evaluated on Appropriateness of changes in paced heart rate with sympathetic tone, correlation between heart rate and sinus rate, and correlation between preejection period and VIP controlled heart rate.
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