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Physiological principles of a new method for rate responsive pacing using the pre-ejection interval.

R Chirife1

  • 1Institute of Cardiology, National Academy of Medicine, Buenos Aires, Argentina.

Pacing and Clinical Electrophysiology : PACE
|November 1, 1988
PubMed
Summary

The pre-ejection interval (PEI) is a reliable indicator for pacemaker rate control during exercise and stress. This study found PEI effectively adjusts pacemaker output to meet physiological demands.

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Area of Science:

  • Cardiology
  • Biomedical Engineering
  • Physiology

Background:

  • Pacemaker technology aims to mimic physiological heart rate responses.
  • The pre-ejection interval (PEI) is a potential parameter for rate-adaptive pacing.
  • Assessing PEI's responsiveness to various physiological stimuli is crucial.

Purpose of the Study:

  • To evaluate the pre-ejection interval (PEI) as a sensor for rate-responsive cardiac pacing.
  • To determine PEI's suitability for adjusting pacemaker output during different physiological conditions.

Main Methods:

  • Measured PEI in 30 patients undergoing isotonic/isometric exercise, emotional stress, isoproterenol infusion, Valsalva maneuver, carotid massage, atropine, and incremental pacing.
  • Used simultaneous atrial rate as a comparator in patients with complete AV block.

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  • Assessed PEI's sensitivity, specificity, proportionality, and speed of response.

    • Main Results:

    • PEI demonstrated prompt and proportional shortening with exercise, emotional stress, and isoproterenol (R=0.88-0.98, p<0.001).
    • PEI was unaffected by preload changes (Valsalva) and parasympathetic stimulation (carotid massage, atropine).
    • Incremental pacing showed minimal effect on PEI, with slight prolongation in some patients.

    Conclusions:

    • The pre-ejection interval (PEI) is a suitable parameter for rate control in physiologically adaptive pacemakers.
    • PEI responds well to exercise and stress, indicating its potential for dynamic pacemaker adjustments.
    • PEI's limited response to parasympathetic and preload changes suggests specificity for rate-adaptive pacing needs.