title: Phase I and Phase II oxygen uptake kinetics during atrioventricular dyssynchrony in chronotropically competent pacemaker patients.
abstract: OBJECTIVE
  To elucidate the effects of atrioventricular (AV) dyssynchrony on phase I and phase II oxygen uptake (V(O2)) kinetics in chronotropically competent pacemaker patients during exercise of an intensity comparable to activities of daily living.
  
  
  METHODS
  Blinded patients completed sub-ventilatory threshold (VT) work rate (WR) cycle ergometry exercise in random order during asynchronous AV pacing (AV OFF) and synchronous AV pacing.
  
  
  METHODS
  Tertiary care hospital in a major city.
  
  
  METHODS
  Six chronotropically competent male pacemaker patients (mean [+/- SD] age, 68 +/- 10 years) with high-degree AV block and varying cardiac histories.
  
  
  RESULTS
  The phase I and phase II V(O2) amplitude response and gain (deltaV(O2)/WR ratio) were lower (p < 0.05) and the time course of phase II was slower (p < 0.05) during AV OFF; however, the O2 deficit was similar (p > 0.05) across pacing modes. The stroke volume index (SVI) was consistently lower (p < 0.05) during AV OFF pacing and was significantly correlated with the time course of phase II V(O2). A significant compensatory amplitude response in heart rate (HR) was observed in addition to a higher (p < 0.05) deltaHR/V(O2) ratio during AV OFF. Ventilatory responses were consistent with ventilatory-perfusion mismatching and perceived exertion was higher during asynchronous pacing.
  
  
  CONCLUSIONS
  This study demonstrated that the contribution of SVI affects V(O2) kinetics and underscores the importance of the atrial contribution to ventricular filling and, consequently, to metabolic and hemodynamic responses. This study supports the theory of an O2 transport limitation and further implicates SV as a potential limiting factor during sub-VT exercise intensities that are comparable to those encountered in activities of daily living.
authors.affiliation: Faculty of Kinesiology and Health Studies, University of Regina, SK, Canada.
authors.forename: Corey R
authors.initials: CR
authors.lastname: Tomczak
authors.forename: Wladyslaw
authors.initials: W
authors.lastname: Wojcik
authors.forename: Edward F G
authors.initials: EF
authors.lastname: Busse
authors.forename: Robert G
authors.initials: RG
authors.lastname: Haennel
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D002304:Cardiac Pacing, Artificial; D005080:Exercise Test; D006327:Heart Block / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010101:Oxygen Consumption / Q000502:physiology*; D010138:Pacemaker, Artificial