The effect of rate responsive pacing in patients with angina pectoris on the extent of ischemia on 201-thallium exercise scintigraphy.
In patients with coronary artery disease (CAD), rate responsive pacing is considered to be contraindicated because an increase in heart rate may increase oxygen demand. Although previous studies have shown no subjective increase in ischemia during rate responsive pacing, data from objective assessment have not been documented. The goal of this study was to determine if there was an increase in ischemia on 201-Thallium (201 Tl) exercise scintigraphy in this mode of pacing in patients with CAD and angina. Eighteen consecutive patients with chronic atrial fibrillation and symptomatic bradyarrhythmias with a pacemaker for more than 6 months participated in the study. In VVI and VVIR modes a symptom-limited exercise 201 Tl scintigram was performed in a single blind randomized crossover fashion. Exercise duration, anginal attacks, use of nitroglycerine (NTG) tablets, blood pressure, and analysis of the scintigrams were assessed during each pacing mode. Fifteen men and three women were included (age 65.9 +/- 4.9 years, LVEF 0.44 +/- 0.07). Four were in Class III angina pectoris, and 14 in class II. The mean exercise duration increased 28% in the VVIR group without an increase in anginal attacks per week or the use of NTG tablets. On scintigrams, no differences were seen between the two groups. One patient was withdrawn from the study because of an increase in angina pectoris (AP) attacks during VVIR pacing. Rate responsive pacing is safe and effective in patients with CAD without an increase in subjective and objective signs of ischemia.
van Campen
Linda C M C
LC
Department of Cardiology, Academic Hospital Free University, Amsterdam, The Netherlands. cardiol@azvu.nl
De Cock
Carel C
CC
Visser
Frans C
FC
Visser
Cees A
CA
D000368:Aged; D000787:Angina Pectoris / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000628:therapy; D001281:Atrial Fibrillation / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy; D001919:Bradycardia / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy; D002304:Cardiac Pacing, Artificial / Q000379:methods; D000075202:Contraindications; D003327:Coronary Disease / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000628:therapy; D018592:Cross-Over Studies; D004562:Electrocardiography; D005080:Exercise Test; D005260:Female; D006339:Heart Rate / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010101:Oxygen Consumption / Q000502:physiology*; D011877:Radionuclide Imaging; D016037:Single-Blind Method; D013794:Thallium Radioisotopes
D013794:Thallium Radioisotopes