PACING
Predictors of chronotropic incompetence in the pacemaker patient population
Charité-Campus Mitte, Medizinische Klinik mit Schwerpunkt Kardiologie Angiologie, Pneumologie, Schumannstrasse 20/21, D-10117 Berlin Germany ; Medtronic, Inc. Minneapolis, MN USA
Aims We prospectively evaluated results from cardiopulmonary exercise testing for chronotropic incompetence (CI) in a cohort of 292 pacemaker patients. In addition, we evaluated comorbidity and antiarrhythmic patient data as indicators of CI.
Methods and results On the basis of exercise stress testing and application of the definition of CI by Wilkoff, 51% of our cohort was categorized as having CI. Indications for pacemaker implant for this patient group were 42% atrioventricular block, 56% sinus node disease, and 59% atrial fibrillation. Maximum oxygen uptake (VO2 max) and exercise duration were significantly reduced among CI pacemaker patients, whereas oxygen uptake at the anaerobic threshold remained unchanged. The following clinical characteristics were significant predictors of CI: existence of coronary artery disease (P=0.038), presence of an acquired valvular heart disease (P=0.037), and former cardiac surgery (P=0.041). Age, gender, arterial hypertension, cardiomyopathy, congenital heart disease, left ventricular ejection fraction, and time period between stress-exercise examination and pacemaker implantation were not significant predictors of CI. Chronic antiarrhythmic therapy with digitalis (P=0.013), beta blockers (P=0.036), and amiodarone (P=0.045) were significant predictors of CI. In contrast, medication with class I and IV antiarrhythmics had no significant correlation with CI.
Conclusion We found the following characteristics predictive of CI in this pacemaker patient population: VO2 max, existence of coronary artery disease or acquired valvular heart disease, previous cardiac surgery, as well as medication with digitalis, beta blockers, and amiodarone.
Key Words: Chronotropic incompetence, Pacemaker, Cardiopulmonary exercise testing
Corresponding author. Tel: +49 30 450 513 148; fax: +49 30 450 513 915. E-mail address: christoph.melzer{at}charite.de
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