Effect of pacemaker rate-adaptation on 24 h beat-to-beat heart rate and blood pressure profiles

doi:10.1016/j.eupc.2005.03.005

Europace 2005 7(4):366-373; doi:10.1016/j.eupc.2005.03.005

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Effect of pacemaker rate-adaptation on 24 h beat-to-beat heart rate and blood pressure profiles

Raffaele Quaglione^a, Giovanni Calcagnini^b^,*, Federica Censi^b, Mario Malavasi^a, Marco Raveggi^c, Gianluca Biancalana^c, Pietro Bartolini^b and Giuseppe Critelli^a

^aInstitute of the Heart and Great Vessels, University La Sapienza Rome, Italy; ^bDepartment of Technologies and Health, Istituto Superiore di Sanità Viale Regina Elena 299, 00161 Roma, Italy; ^cBiotronik Seda Milano, Italy

AIMS: The aims of the study were to evaluate the 24-h beat-to-beatheart rate (RR) and blood pressure changes during closed loopstimulation (DDD-CLS) pacing and conventional fixed rate DDDpacing with respect to spontaneous activity.

METHODS: We simultaneously and continuously measured beat-to-beat heartrate and blood pressure for 24 h in patients implanted withInos²⁺ (Biotronik GmbH, Berlin, Germany). A randomised cross-overcomparison of DDD-CLS and DDD pacing was performed by short-and long-term analyses.

RESULTS: Seventeen patients (10 males, aged 46–85 years) were enroledin the study: 11 completed the protocol. The percentage of atrialstimulation was 72.87% during DDD-CLS and 38.36% in DDD (P =0.003). All patients were 100% stimulated in the ventricle.On average, the percentage increase of paced RR intervals withrespect to spontaneous beats was only 7.4% in DDD-CLS but 20.1%in DDD (P = 0.0001). A significant correlation between spontaneousand paced RR profiles was obtained only during DDD-CLS (r_DDD-CLS= 0.77, r_DDD = 0.23, P = 0.01). Short-term analysis revealeda 3.79% reduction of the escape interval in DDD-CLS and 8.19%in DDD, and the relative fall in diastolic blood pressure was1.14% in DDD-CLS and 3.81% in DDD.

CONCLUSION: DDD-CLS provided physiological heart rate fluctuations throughoutthe 24-h test. The blood pressure profiles of paced and spontaneousbeats were comparable. The onset of paced rhythm in DDD-CLSresulted in a less pronounced decrease in heart rate and fallin diastolic pressure than in DDD.

Key Words: Heart rate, Blood pressure, Rate-responsive pacing

^*Corresponding author. Tel.: +390649902862; fax: +390649387079. E-mail address: giovanni.calcagnini{at}iss.it (G. Calcagnini).

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