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Related Experiment Videos

Physiological versus single-rate ventricular pacing: a double-blind cross-over study.

B E Kristensson, K Arnman, P Smedgård

    Pacing and Clinical Electrophysiology : PACE
    |January 1, 1985
    PubMed
    Summary

    Atrioventricular synchronous pacing significantly improved exercise tolerance and patient well-being compared to ventricular inhibited pacing. This physiological pacing mode enhanced functional capacity and was preferred by most patients in a blinded study.

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    Area of Science:

    • Cardiology
    • Biomedical Engineering
    • Exercise Physiology

    Background:

    • Atrioventricular synchronous pacing (AS) offers physiological cardiac rhythm management.
    • Previous studies comparing AS and ventricular inhibited pacing (VI) often lack robust bias control.
    • Optimizing pacemaker settings is crucial for patient quality of life and exercise capacity.

    Purpose of the Study:

    • To evaluate the impact of AS versus VI on maximal and submaximal exercise tolerance.
    • To assess subjective well-being and symptom perception in patients under different pacing modes.
    • To mitigate biases inherent in open-label study designs through a blinded, randomized approach.

    Main Methods:

    • A randomized, blinded crossover study involving 44 patients with long-term AV synchronous pacemakers.

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  • Patients experienced 3-week periods of both AS and VI pacing modes.
  • Assessments included echocardiography, symptom-limited maximal exercise testing, and subjective symptom questionnaires.

    • Main Results:

    • Maximal exercise tolerance increased by 14% (p<0.01) during AS pacing.
    • Higher arterial lactate, respiratory rates, and perceived exertion were noted during VI pacing.
    • Patients reported fewer symptoms and improved functional class with AS pacing, expressing a preference for it.

    Conclusions:

    • Atrioventricular synchronous pacing demonstrates superior efficacy in enhancing exercise tolerance and subjective well-being compared to ventricular inhibited pacing.
    • The findings support the clinical benefit of physiological pacing strategies in pacemaker patients.
    • Blinded, randomized trials are essential for accurately assessing pacemaker mode efficacy and patient outcomes.