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Exercise testing for chronotropic assessment
1Department of Cardiology, Cleveland Clinic Foundation, Ohio.
Cardiology Clinics
|November 1, 1992
Summary
Cardiac chronotropic analysis is advancing with rate-responsive pacemakers, enabling better assessment of heart rate response during exercise. Formal testing is crucial for optimizing pacemaker function to meet metabolic demands.
Area of Science:
- Cardiology
- Exercise Physiology
Background:
- Cardiac chronotropic analysis is an emerging clinical science.
- Formal exercise testing traditionally focused on ischemia and cardiac rehabilitation.
- Rate-responsive pacemakers necessitate understanding cardiac chronotropism and pacemaker response.
Purpose of the Study:
- To define cardiac chronotropism and assess pacemaker response.
- To investigate the normal chronotropic response, particularly in patients with ventricular dysfunction or ischemia.
- To establish standards for chronotropic evaluation.
Main Methods:
- Utilizing modern rate-responsive pacemakers as a clinical laboratory.
- Employing advanced telemetry, including sensor and actual rate trends, histograms, and sensorgraphy.
- Conducting formal exercise testing to gather previously unobtainable clinical data.
Main Results:
- Modern pacemakers provide an ideal platform for investigating cardiac chronotropism.
- Advanced telemetry generates unprecedented clinical data on heart rate response.
- Standards are being established for chronotropic evaluation.
Conclusions:
- Formal exercise testing is essential for achieving optimal chronotropic evaluations.
- The goal is to match pacemaker-augmented heart rate to the body's metabolic requirements in chronotropically incompetent patients.
- Further research is needed to fully understand normal and abnormal chronotropic responses.