Europace Advance Access originally published online on February 13, 2008
Europace 2008 10(3):327-333; doi:10.1093/europace/eun024
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PACING
Closed loop stimulation and accelerometer-based rate adaptation: results of the PROVIDE study
1 Department of Cardiology, University Hospital, Petersgraben 4, 4031 Basel, Switzerland; 2 Helios Clinic, Aue, Germany; 3 District Hospital, Neustadt/Aisch, Germany; 4 Friedrich-Ebert Hospital, Neumuenster, Germany; 5 St Johannes Hospital, Dortmund, Germany; 6 Medical University Clinic, Graz, Austria; 7 Department of Cardiology, University of Wuerzburg, Germany; 8 Cantonal Hospital, Liestal, Switzerland; 9 Medical University Clinic, Heidelberg, Germany; 10 Cardiac Catheterization Laboratory, Munich, Germany; 11 St Agnes Hospital, Bocholt, Germany; 12 Regional Hospital, Ebersberg, Germany; 13 St Josef Hospital, Bochum, Germany
Aims: We compared pacing rate adaptation based on closed loop stimulation (CLS) or accelerometer sensor (AS) during acute mental and physical stress in the same patient.
Methods and results: One month after Protos (Biotronik, Germany) pacemaker implantation, 131 chronotropically incompetent patients were randomized to AS or CLS for 3 months with crossover. Arithmetic and 6 min walk tests were performed in the non-rate-adaptive mode and AS and CLS rate-adaptive modes, respectively. At the end, patients had to select the individually preferred pacemaker sensor. Heart rate during mental stress was higher (3.0 ± 9.2 bpm) in the CLS than in the AS mode (P = 0.004). Benefit in the walking distance compared with non-rate-adaptive pacing was similar for the two modes: added 27 ± 96 m (AS, P = 0.013) and 30 ± 116 m (CLS, P = 0.025). At the end of the walk, heart rate was higher by 4.8 ± 21.4 bpm in AS than in CLS (P = 0.049). Twice as many patients preferred CLS over AS (P < 0.01).
Conclusion: The arithmetic test was associated with a significantly higher heart rate for CLS than for AS, showing a greater sensitivity of CLS-based rate adaptation to mental stress. Performance during physical stress was comparable. Patients preferred CLS.
Key Words: Rate-adaptive pacing, Chronotropic incompetence, Closed loop stimulation, Accelerometer sensor, Mental stress, Physical stress
* Corresponding author. Tel: +41 61 265 2525; fax: +41 61 265 4598. E-mail address: mcoenen{at}uhbs.ch
Manuscript submitted 19 September 2007. Accepted after revision 12 January 2008.