The A-R interval as exercise indicator: a new option for rate adaptation in single and dual chamber pacing

We investigated the possibility to use the interval from an atrial stimulus to the ventricular R wave (A-R interval) as an indicator of physical stress, in 16 patients with pacemakers implanted for severe atrial bradycardia but with intact AV conduction. The A-R interval was studied during incremental atrial pacing at rest and during exercise with a constant workload. In addition, the atrial pacing rate was kept constant just above spontaneous sinus rate and the dynamics of the A-R interval were studied during exercise with a low constant workload and during a maximal exercise test with increasing workload. Incremental atrial pacing prolonged the A-R interval and this response was blunted during exercise (P less than 0.003). Atrial pacing at a constant rate and during a constant workload resulted in an almost direct shortening of the A-R interval. When the workload was increased but the atrial rate kept constant, a pronounced shortening of the A-R interval was noted (P less than 0.0001). It is concluded that changes of the A-R interval during different kinds of exercise were prompt and predictable in patients with sinus node dysfunction but intact AV conduction. In these patients the shortening of the A-R interval during exercise may be a suitable indicator for rate adaptive atrial pacing.