Catecholamine Levels and Pacing Behavior of QT‐Driven Pacemakers During Exercise

Jordaens, Luc; Backers, Jos; Moerman, E; Clément, Denis

doi:10.1111/j.1540-8159.1990.tb02076.x

Cited by 10 publications

(2 citation statements)

References 14 publications

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“…The premise of QT-interval-based sensors is that by measuring a surrogate of the adrenergic tone, proportional heart rate response may be predicted. 7 …”

Section: Evoked Qt-interval-based Sensorsmentioning

confidence: 99%

“…6 During the initial aerobic part of exercise, there is a steady increase in serum catecholamine level proportionate to oxygen consumption. 7 Increasing sympathetic tone shifts the blood flow to the heart and muscles, increases chronotropy and inotropy, and augments blood return to the heart. There is also interdependence between the cardiac and pulmonary systems.…”

Section: Sensors For Rate Modulation Rate Modulationmentioning

confidence: 99%

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Device Sensing

Kaszala

Ellenbogen

2010

Circulation

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evice therapy for the management of cardiac arrhythmias has evolved from asynchronous pacing in postsurgical heart block and Stokes-Adams attacks 1 to the use of implantable cardioverter defibrillator (ICDs) 2 and cardiac resynchronization therapy for the prevention of sudden cardiac death and the treatment of heart failure. 3 Algorithms have been developed to optimize pacemaker response during arrhythmias and minimize pacing if indicated by cardiac physiology. Over the last several decades, technological advances and a better understanding of cardiac physiology allowed the development and miniaturization of devices that not only monitor and react to the electric signals from intracardiac electrograms but also use physiological signals to optimize pacing function and monitor disease state. It has become a reality to store this information in modern devices and transmit it to a clinical center, even on a daily basis if needed, by use of a transtelephonic or Internet-based route. As current and emerging indications for device therapy have targeted increasingly larger patient populations, 4 we are now able to use implantable devices to monitor patients at risk of adverse cardiac events.Emerging technologies aim to provide continuous hemodynamic information to aid the management of chronic heart failure. Technologies under clinical investigation include impedance-based monitoring of fluid status, hemodynamic assessment based on pulmonary artery pressure and its derivatives, or direct left atrial pressure monitoring. A promising possibility is that the information obtained from monitors may be used to predict and avoid adverse clinical outcomes earlier than changes in clinical parameters would otherwise indicate, which would allow physicians an opportunity for earlier intervention. In the present review, we will discuss currently used sensors in cardiac devices and draw attention to some of the future applications of device sensors. Sensors for Rate Modulation Rate ModulationStudies in the 1970s demonstrated that adequate cardiac output during exercise predominantly relies on increases in heart rate, 5 especially if cardiac dysfunction is present. This notion resulted in increased efforts to develop pacing systems that mimic sinus node function and allow rate modulation in patients with sinus node disease or chronotropic incompetence. Normal cardiovascular response to exercise is very complex. The normal well-concerted response is the result of a prompt change in heart rate caused by the interplay between neural, humoral, and hemodynamic inputs to the heart. A detailed discussion of exercise physiology is beyond the scope of the present review, but it is important to understand some basic principles to appreciate the difficulties in simulating normal chronotropy and to understand the limitations of individual sensors.Aerobic metabolism requires an adequate supply of oxygen transported from the lungs to the tissues by means of the circulation. Thus, both cardiovascular and pulmonary systems play a key role in meeting ...

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“…The premise of QT-interval-based sensors is that by measuring a surrogate of the adrenergic tone, proportional heart rate response may be predicted. 7 …”

Section: Evoked Qt-interval-based Sensorsmentioning

confidence: 99%

Section: Sensors For Rate Modulation Rate Modulationmentioning

confidence: 99%

Device Sensing

Kaszala

Ellenbogen

2010

Circulation

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Sensor and Sensor Integration

Rea¹

2005

New Arrhythmia Technologies

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Heart rate and catecholamine contribution to qt interval shortening on exercise

Davey

Bateman

1999

Clinical Cardiology

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SummaryBackground: QT interval shortens with exercise. Some of this shortening is due to an increase in heart rate, and some is due to other effects of exercise, probably mostly neuroendocnne effects. Data from subjects with cardiac transplants have suggested that non-heart rate-related changes in QT interval on exercise are due to the effects of circulating catecholamines.Hypothesis: We sought to determine whether changes in plasma catecholamine levels with exercise are an important contributor to non-heart rate-related QT interval shortening.Methods: Subjects with DDD pacemakers were recruited. Subjects had QT intervals measured at rest, during a low fixed level exercise test designed to increase heart rate to about 110 beatshin, and, after resting, during pacing at a heart rate of 110 beatshin. Catecholamine levels were measured at each stage of the study.

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Catecholamine Levels and Pacing Behavior of QT‐Driven Pacemakers During Exercise

Cited by 10 publications

References 14 publications

Device Sensing

Device Sensing

Sensor and Sensor Integration

Heart rate and catecholamine contribution to qt interval shortening on exercise

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