Cardiac rehabilitation in patients with rate responsive pacemakers

This study investigated the suitability of our oxygen pulse reserve (OPR) method for tailoring parameters of rate responsive pacemakers and planning aerobic rehabilitation programs. We selected 11 patients, NYHA Classes I-III (7 males and 4 females; mean age 60 years, range 18-83), with rate responsive pacemakers implanted for high degree AV block and chronotropic incompetence. Five pacemakers had activity sensors, 4 had temperature sensors, and 2 had dual sensors. All patients underwent a cardiopulmonary stress test (CPX). We determined anaerobic threshold time (ATT), VO2/AT, total exercise time (TET), VO2 Max, and VO2 AT/VO2 Max. OPR (mL-O2/beat) was calculated for each patient using the formula OPR = (VO2 Max - VO2 resting)/(HR Max - HR resting). During CPX, this slope was used as the rate response tailoring guideline by comparing the mL-O2/beat equation and the pacing rate. Rate response settings were modified until the optimal relationship between theoretical and paced rate was obtained. The work protocol yielded rate response settings capable of providing pacing rates within +/- 10 beats of the theoretical values. Data relating to theoretical and measured rates have been analyzed statistically. Patients underwent an aerobic rehabilitation program that followed the American College of Sports Medicine guidelines. Pacing rate at the anaerobic threshold was considered the border for an aerobic workload. After 2-7 months, all patients showed an evident improvement in ATT (92%), VO2/AT (48%), TET (49%), VO2 Max (23%), and VO2 AT/VO2 (21%). Particularly, two patients improved from Weber Class C to A, and three improved from C to B. At each CPX step, the mean values of pacing rate and theoretical rate almost overlap, and the relevant coefficients suggest an excellent correlation (P < 0.001). Our OPR method for tailoring rate response provides the basis for an effective rehabilitation program with functional advantages for patients.