Improvement of exercise tolerance by single lead VDD pacemaker: evaluation using cardiopulmonary exercise test

We used a cardiopulmonary test to assess the physiological benefit of single lead VDD pacing in ten patients (six men, four women; aged 32-84 years, mean 69 years) with atrioventricular block. Maximal symptom-limited treadmill exercise test using a ramp protocol was performed under VDD and VVIR or VVI pacing (VVI) in random sequence. The pacemaker was then programmed to the VDD mode, and Holter ECG was recorded in nine patients. Compared with findings during the VVI, the VDD mode had a greater chronotropic response (mean maximal heart rate, VDD 106 +/- 17 beats/min vs VVI 79 +/- 19 beats/min, P = 0.03), and was associated with prolongation of exercise duration (VDD 11.2 +/- 2.9 minute vs VVI 10.5 +/- 3.1 minute; P = 0.01), and the onset of anaerobic threshold at a higher oxygen uptake (VDD 12.4 +/- 3.4 mL/min per kilogram vs VVI 10.0 +/- 2.1 mL/min per kilogram; P < 0.01). Atrial sensing was recognized in almost all normal sinus P waves for all cases examined using Holter ECG. Thus, chronotropic response during exercise by VDD pacemaker improved exercise tolerance, indicating that a VDD pacemaker might be useful for patients requiring physical activity.