Abstract. Background A pacemaker not only has the role of preventing the heart rate from dropping under a certain limit, but can also have an important influence on the exercise capacity (1), as the pacing mode influences atrioventricular synchronicity (single-chamber vs. dual-chamber pacemakers) (2, 3) and the response of the heart rate to physical exercise (rate responsive function, mode switch function) (4, 5).Most patients who have a pacemaker implanted for sick sinus syndrome or for atrioventricular blocks need to be enrolled in cardiac rehabilitation programs in order to improve their exercise capacity and quality of life. One of the most important components of cardiac rehabilitation is physical exercise, a programme that needs to be individualized for each patient by taking into account various factors such as age, gender, risk factors, comorbidities, and fitness level (6).The first step in prescribing a physical training plan is the evaluation of the maximum exercise capacity of the patient through a standardized exercise stress test, noting the symptoms that forced the patient to stop the test, the maximum workload, the variations of the patient's blood pressure, heart rate, oxygen saturation, significant arrhythmias or ischemic changes recorded on the electrocardiographic (ECG) monitoring (7-9).Besides the parameters mentioned above, the pacemakerwearing patient needs a more complex assessment during exercise because some particular events might occur: the heart rate might not adapt to exercise in patients with chronotropic incompetence, resulting in early left ventricular failure; atrioventricular conduction disturbances could worsen, causing symptoms such as dyspnoea, dizziness or even syncope; tachyarrhythmia or ischemic changes can be difficult to diagnose on an ECG recording during paced atrial or ventricular beats (10, 11).In the present study, we focused on the exercise capacity of patients with cardiac pacemakers and on the benefits or the disadvantages brought by choosing a particular programming mode. Most of the studies that evaluated the exercise capacity of pacemaker-wearing patients enrolled a limited number of individuals and returned discordant results.The purpose of our study was to compare the influence of the most common pacemaker programming modes on the exercise capacity of the patients.
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