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Ann Thorac Surg 1986;42:201-205
© 1986 The Society of Thoracic Surgeons

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Articles

Increase in Cardiac Output with Rate-Responsive Pacemaker

Divisions of Thoracic and Cardiovascular Surgery and of Nuclear Medicine, J. W. Goethe University, Frankfurt/M, West Germany

^* Address reprint requests to Dr. Beyersdorf, Abteilung fü;r Thorax-, Herz-u. Gefaesschirurgie, Zentrum der Chirurgie, Klinikum der J. W. Goethe-Universitaet, Theodor-Stern-Kai, D-6000 Frankfurt/M 70, West Germany

Patients with myocardial insufficiency or patients during high cardiac work loads increase cardiac output (CO) only through an increase in heart rate (HR), which is not possible with a VVI pacemaker. This clinical study tests the hypothesis that the respiratory-dependent pacemaker (RDP) is able to increase CO by an increase in HR.

A multiprogrammable RDP (BIOrate RDP 2, Alpha, Kö;ln, West Germany) was implanted in 21 patients (16 men and 5 women) for ventricular pacing. The mean age of the patients was 68.1 ± 9.5 years (± standard deviation). Since the RDP can be programmed either in the RDP or VVI mode, all patients served as their own control. During follow-up examinations 4 to 6 weeks after implantation, an exercise ECG and a determination of CO during rest and exercise using equilibrium-radionuclide ventriculography were performed.

One pacemaker has had to be explanted because of "end of life." No other RDP is malfunctioning. There was a significant increase in HR in all patients during exercise with the RDP versus the VVI mode (105.5 ± 5.9 versus 84.5 ± 7.0 bpm; p < 0.05). CO increased during exercise to 10.6 ± 0.8 L/min (VVI mode) and 12.7 ± 1.5 L/min (RDP mode) (p = not significant). RDPs are reliable systems for patients in whom dual-chambered pacemakers are contraindicated (e.g., patients with bradyarrhythmias). The RDPs are able to increase CO by 26 to 35% compared with the VVI mode because of an increase in HR.

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