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The optimal pacing rate: an unpredictable parameter

G Payne1, J Spinelli, C J Garratt

  • 1Research Registrar, Glenfield Hospital, Leicestershire, United Kingdom.

Pacing and Clinical Electrophysiology : PACE
|April 1, 1997
PubMed
Summary
This summary is machine-generated.

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This study defines the "optimal rate" for heart pacing. Researchers found that current methods for determining optimal heart rates may be inaccurate, potentially impairing patient hemodynamics.

Area of Science:

  • Cardiology
  • Physiology
  • Biomedical Engineering

Background:

  • The relationship between heart rate and cardiac output exhibits a three-phase pattern: increase, plateau, and decrease.
  • The
  • optimal rate
  • is the heart rate at the onset of the plateau phase (Phase II).

Purpose of the Study:

  • To investigate the
  • optimal rate band
  • in patients with chronic complete heart block and DDD pacing during exercise.
  • To evaluate the accuracy of current chronotropic incompetence definitions and age-related pacing rate selection.

Main Methods:

  • Twenty patients (13 male, mean age 60) underwent maximal exercise testing to determine peak sinus rate.

Related Experiment Videos

  • Ambulatory hemodynamic monitoring (Capintec Vest) measured relative cardiac output and ejection fraction.
  • Patients were programmed to VVI pacing, with rates incrementally increased during exercise to determine the
  • optimal rate band
  • at various workloads.

    • Main Results:

    • The mean
    • optimal rate band
    • varied non-linearly across different exercise workloads.
    • No correlation was found between the mean optimal rate and patient age or predicted peak heart rate (Astrand formula).

    Conclusions:

    • Current definitions of chronotropic incompetence may be inaccurate.
    • Arbitrary selection of pacemaker rate response curves based on age may lead to suboptimal hemodynamic performance.
    • Further research is needed to refine optimal pacing strategies for improved patient outcomes.