Key result
Overpacing prolongs AV conduction time by ~4 ms per 10 beats/min during exercise.
Why the study?
The influence of pacing rate on atrioventricular conduction time during exercise was investigated to develop basic concepts for a dromotropic rate responsive pacemaker algorithm.
Does pacing rate manipulation affect atrioventricular conduction time during aerobic and anaerobic exercise in patients with sick sinus syndrome?
Does pacing rate manipulation affect atrioventricular conduction time during aerobic and anaerobic exercise in patients with sick sinus syndrome?
There is a reciprocal relationship between heart rate and atrioventricular conduction time during exercise, providing a basic physiological concept for a dromotropic rate-responsive pacemaker algorithm.
Answers are grounded in this paper and cite their sources.
May influence AV conduction during exercise with rate changes; hypothesis-generating for optimized device programming and needs prospective validation.
The dromotropic pacemaker concept needs a rate responsive algorithm in which the pacing rate is controlled by the atrioventricular conduction time (AVCT). To develop basic concepts for such a rate responsive algorithm, the influence of the pacing rate on the AVCT was investigated. Seven patients (62 +/- 7.8 years) with sick sinus syndrome and intact atrioventricular conduction underwent two cardiopulmonary exercise tests (CPX) on a treadmill. According to the determination of the anaerobic threshold (AT) and the patients maximum capacity in the first incremental CPX the work rate for two exercise levels below and above the AT were chosen for the second constant workload CPX. The calculation of the optimal pacing rate (HRopt) was based on the oxygen uptake (VO2) during exercise after reaching steady-state conditions. According to the increase of the VO2 from 14.8 +/- 2.3 mL/min per kilogram during aerobic work (38.3 +/- 16.0 W) to 19.4 +/- 4.7 mL/min per kilogram during anaerobic work (80.6 +/- 32.3 W), the HRopt was calculated to be 98.6 +/- 6.9 beats/min and 116.4 +/- 4.7 beats/min. Starting from HRopt, the pacing rate was increased (overpacing) and decreased (underpacing) by about 5 beats/min every minute. At optimal pacing rate the AVCT decreased significantly from 233.0 +/- 30.5 ms during aerobic work and to 226.4 +/- 27.3 ms during anaerobic work (P < 0.05). Whereas overpacing induced a significant prolongation of the AVCT during aerobic work (4.17 +/- 1.78 ms per 10 beats/min) and anaerobic work (3.84 +/- 1.60 ms per 10 beats/min), underpacing yielded a significant shortening of the AVCT by about 4.49 +/- 2.64 ms per 10 beats/min during aerobic work and 4.75 +/- 1.87 ms per 10 beats/min during anaerobic work (P < 0.01). The slopes of the regression lines of the relationship between AVCT and pacing rate were not significantly. different. Based on the reciprocal relationship of heart rate (HR) and AVCT, basic concepts may be established for a dromotropic rate responsive algorithm.
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Meine et al. (1999) studied Sick sinus syndrome (n=7). Pacing rate adjustment (overpacing and underpacing) vs. Optimal pacing rate was evaluated on Atrioventricular conduction time (AVCT) (p=<0.01). Overpacing prolonged atrioventricular conduction time by ~4 ms per 10 beats/min, whereas underpacing significantly shortened it by ~4.5-4.7 ms per 10 beats/min during exercise (P<0.01).
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