Improving lung function capacity in patients with chronotropic incompetence using closed loop stimulation: A randomized crossover study.

IF 4.6 Q2 MATERIALS SCIENCE, BIOMATERIALS ACS Applied Bio Materials Pub Date : 2024-10-20 DOI:10.1016/j.jfma.2024.10.009

Wen-Ling Chen, Lung-Ching Chen, Pei-Sung Hsu, Kou-Gi Shyu, Huei-Fong Hung, Shih-Huang Lee, Tzu-Lin Wang, Wei-Ting Lai, Kuan-Jen Chen, Zhen-Yu Liao, Cheng-Yen Chuang, Ching-Yao Chou, Su-Kiat Chua

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Abstract

Background: Chronotropic incompetence (CI) severely limits exercise tolerance due to impaired heart rate responses. This study investigated whether pacemaker with closed-loop stimulation (DDD-CLS) pacing, which provides rate acceleration in response to exertion, could enhance lung function and cardiopulmonary capacity compared pacemaker without CLS pacing in patients with CI.

Methods: This randomized crossover trial included 32 patients with CI who were compared to each CLS and DDD pacing over 2 months. Spirometry was used to assess the forced vital capacity (FVC). Cycling-based cardiopulmonary exercise testing (CPET) measured peak oxygen uptake (peak VO₂).

Results: DDD-CLS pacing yielded significantly higher FVC (2.2 ± 0.8 L) versus DDD pacing (2.0 ± 0.7 L), p = 0.036, a 3.2% improvement. Moreover, those in the DDD-CLS mode showed a significantly higher FEV1 of 1.8 ± 0.6 L compared to the DDD mode of 1.7 ± 0.5 L (p = 0.03). Compared with DDD pacing, DDD-CLS pacing also achieved superior peak VO₂ (14.9 ± 4.0 vs 12.2 ± 3.7 mlO₂/kg/min, p < 0.001) and peak heart rate (106.9 ± 9.7 vs 98.3 ± 19.8 bpm, p = 0.013). DDD-CLS and DDD pacing modes showed significant correlations between FVC and peak VO₂ and between peak VO₂ and peak heart rate during CPET.

Conclusions: Compared with DDD mode, DDD-CLS pacing provided physiological chronotropic support to improve cardiopulmonary function during exertion, which enhanced lung capacity in patients with CI.

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利用闭环刺激改善时相失调患者的肺功能容量：随机交叉研究

背景：由于心率反应受损，慢性心律失常（CI）严重限制了运动耐量。本研究探讨了带闭环刺激（DDD-CLS）起搏的心脏起搏器与不带 CLS 起搏的心脏起搏器相比，能否提高 CI 患者的肺功能和心肺能力：这项随机交叉试验包括 32 名 CI 患者，他们在两个月内分别接受 CLS 和 DDD 起搏。采用肺活量测定法评估强迫生命容量（FVC）。循环心肺运动测试（CPET）测量峰值摄氧量（峰值 VO2）：结果：DDD-CLS 起搏的 FVC（2.2 ± 0.8 L）明显高于 DDD 起搏（2.0 ± 0.7 L），P = 0.036，提高了 3.2%。此外，采用 DDD-CLS 模式的患者的 FEV1 为 1.8 ± 0.6 L，明显高于 DDD 模式的 1.7 ± 0.5 L（p = 0.03）。与 DDD 起搏相比，DDD-CLS 起搏也能获得更高的峰值 VO2（14.9 ± 4.0 vs 12.2 ± 3.7 mlO2/kg/min，p 2 和 CPET 期间峰值 VO2 与峰值心率之间的关系）：结论：与 DDD 模式相比，DDD-CLS 起搏可提供生理时变支持，改善 CI 患者用力时的心肺功能，从而提高肺活量。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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