title: Closed loop stimulation and accelerometer-based rate adaptation: results of the PROVIDE study.
abstract: OBJECTIVE
  We compared pacing rate adaptation based on closed loop stimulation (CLS) or accelerometer sensor (AS) during acute mental and physical stress in the same patient.
  
  
  RESULTS
  One month after Protos (Biotronik, Germany) pacemaker implantation, 131 chronotropically incompetent patients were randomized to AS or CLS for 3 months with crossover. Arithmetic and 6 min walk tests were performed in the non-rate-adaptive mode and AS and CLS rate-adaptive modes, respectively. At the end, patients had to select the individually preferred pacemaker sensor. Heart rate during mental stress was higher (3.0 +/- 9.2 bpm) in the CLS than in the AS mode (P = 0.004). Benefit in the walking distance compared with non-rate-adaptive pacing was similar for the two modes: added 27 +/- 96 m (AS, P = 0.013) and 30 +/- 116 m (CLS, P = 0.025). At the end of the walk, heart rate was higher by 4.8 +/- 21.4 bpm in AS than in CLS (P = 0.049). Twice as many patients preferred CLS over AS (P < 0.01).
  
  
  CONCLUSIONS
  The arithmetic test was associated with a significantly higher heart rate for CLS than for AS, showing a greater sensitivity of CLS-based rate adaptation to mental stress. Performance during physical stress was comparable. Patients preferred CLS.
authors.affiliation: Department of Cardiology, University Hospital, Petersgraben 4, 4031 Basel, Switzerland. mcoenen@uhbs.ch
authors.forename: Martin
authors.initials: M
authors.lastname: Coenen
authors.forename: Klaus
authors.initials: K
authors.lastname: Malinowski
authors.forename: Wilhelm
authors.initials: W
authors.lastname: Spitzer
authors.forename: Andreas
authors.initials: A
authors.lastname: Schuchert
authors.forename: Dietmar
authors.initials: D
authors.lastname: Schmitz
authors.forename: Michael
authors.initials: M
authors.lastname: Anelli-Monti
authors.forename: Sebastian K G
authors.initials: SK
authors.lastname: Maier
authors.forename: Werner
authors.initials: W
authors.lastname: Estlinbaum
authors.forename: Alexander
authors.initials: A
authors.lastname: Bauer
authors.forename: Holger
authors.initials: H
authors.lastname: Muehling
authors.forename: Franz
authors.initials: F
authors.lastname: Kalscheur
authors.forename: Klaus
authors.initials: K
authors.lastname: Puerner
authors.forename: Jan
authors.initials: J
authors.lastname: Boergel
authors.forename: Stefan
authors.initials: S
authors.lastname: Osswald
mesh_terms: D000222:Adaptation, Physiological / Q000502:physiology*; D000368:Aged; D000369:Aged, 80 and over; D002304:Cardiac Pacing, Artificial / Q000379:methods*; D018592:Cross-Over Studies; D005080:Exercise Test; D005260:Female; D005500:Follow-Up Studies; D006339:Heart Rate / Q000502:physiology*; D006801:Humans; D007361:Intelligence Tests; D008297:Male; D008875:Middle Aged; D010138:Pacemaker, Artificial; D017060:Patient Satisfaction; D011446:Prospective Studies