[Chronotropic incompetence: when should a pacemaker be considered? Which pacing system and which settings?].
Chronotropic incompetence is defined as the inability to increase and maintain heart rate appropriately during exercise. Intolerance to exertion is manifested by a number of clinical symptoms, and is almost obligatory if heart rate cannot be increased. Several rate-modulating pacing systems have been developed. The most obvious and reliable way to increase heart rate during exercise is to detect the sinus node. Adding an atrial lead in a patient in complete AV block and VVI pacing is the most satisfactory way to correct chronotropic incompetence in some patients. Rate-adaptive sensors include motion sensors, respiration sensors, QT interval, and right ventricular contractility. Indications for rate-adaptive pacing should be based on clinical symptoms, demonstration of a lack of cardiac acceleration during exercise, and the presence of another indication for pacing.
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D006331:Heart Diseases / Q000503:physiopathology* / Q000601:surgery*; D006339:Heart Rate; D006801:Humans; D010138:Pacemaker, Artificial