{"title":"利用闭环刺激改善时相失调患者的肺功能容量：随机交叉研究","authors":"Wen-Ling Chen, Lung-Ching Chen, Pei-Sung Hsu, Kou-Gi Shyu, Huei-Fong Hung, Shih-Huang Lee, Tzu-Lin Wang, Wei-Ting Lai, Kuan-Jen Chen, Zhen-Yu Liao, Cheng-Yen Chuang, Ching-Yao Chou, Su-Kiat Chua","doi":"10.1016/j.jfma.2024.10.009","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Chronotropic incompetence (CI) severely limits exercise tolerance due to impaired heart rate responses. This study investigated whether pacemaker with closed-loop stimulation (DDD-CLS) pacing, which provides rate acceleration in response to exertion, could enhance lung function and cardiopulmonary capacity compared pacemaker without CLS pacing in patients with CI.</p><p><strong>Methods: </strong>This randomized crossover trial included 32 patients with CI who were compared to each CLS and DDD pacing over 2 months. Spirometry was used to assess the forced vital capacity (FVC). Cycling-based cardiopulmonary exercise testing (CPET) measured peak oxygen uptake (peak VO<sub>2</sub>).</p><p><strong>Results: </strong>DDD-CLS pacing yielded significantly higher FVC (2.2 ± 0.8 L) versus DDD pacing (2.0 ± 0.7 L), p = 0.036, a 3.2% improvement. Moreover, those in the DDD-CLS mode showed a significantly higher FEV1 of 1.8 ± 0.6 L compared to the DDD mode of 1.7 ± 0.5 L (p = 0.03). Compared with DDD pacing, DDD-CLS pacing also achieved superior peak VO<sub>2</sub> (14.9 ± 4.0 vs 12.2 ± 3.7 mlO<sub>2</sub>/kg/min, p < 0.001) and peak heart rate (106.9 ± 9.7 vs 98.3 ± 19.8 bpm, p = 0.013). DDD-CLS and DDD pacing modes showed significant correlations between FVC and peak VO<sub>2</sub> and between peak VO<sub>2</sub> and peak heart rate during CPET.</p><p><strong>Conclusions: </strong>Compared with DDD mode, DDD-CLS pacing provided physiological chronotropic support to improve cardiopulmonary function during exertion, which enhanced lung capacity in patients with CI.</p>","PeriodicalId":2,"journal":{"name":"ACS Applied Bio Materials","volume":null,"pages":null},"PeriodicalIF":4.6000,"publicationDate":"2024-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Improving lung function capacity in patients with chronotropic incompetence using closed loop stimulation: A randomized crossover study.\",\"authors\":\"Wen-Ling Chen, Lung-Ching Chen, Pei-Sung Hsu, Kou-Gi Shyu, Huei-Fong Hung, Shih-Huang Lee, Tzu-Lin Wang, Wei-Ting Lai, Kuan-Jen Chen, Zhen-Yu Liao, Cheng-Yen Chuang, Ching-Yao Chou, Su-Kiat Chua\",\"doi\":\"10.1016/j.jfma.2024.10.009\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Chronotropic incompetence (CI) severely limits exercise tolerance due to impaired heart rate responses. This study investigated whether pacemaker with closed-loop stimulation (DDD-CLS) pacing, which provides rate acceleration in response to exertion, could enhance lung function and cardiopulmonary capacity compared pacemaker without CLS pacing in patients with CI.</p><p><strong>Methods: </strong>This randomized crossover trial included 32 patients with CI who were compared to each CLS and DDD pacing over 2 months. Spirometry was used to assess the forced vital capacity (FVC). Cycling-based cardiopulmonary exercise testing (CPET) measured peak oxygen uptake (peak VO<sub>2</sub>).</p><p><strong>Results: </strong>DDD-CLS pacing yielded significantly higher FVC (2.2 ± 0.8 L) versus DDD pacing (2.0 ± 0.7 L), p = 0.036, a 3.2% improvement. Moreover, those in the DDD-CLS mode showed a significantly higher FEV1 of 1.8 ± 0.6 L compared to the DDD mode of 1.7 ± 0.5 L (p = 0.03). Compared with DDD pacing, DDD-CLS pacing also achieved superior peak VO<sub>2</sub> (14.9 ± 4.0 vs 12.2 ± 3.7 mlO<sub>2</sub>/kg/min, p < 0.001) and peak heart rate (106.9 ± 9.7 vs 98.3 ± 19.8 bpm, p = 0.013). DDD-CLS and DDD pacing modes showed significant correlations between FVC and peak VO<sub>2</sub> and between peak VO<sub>2</sub> and peak heart rate during CPET.</p><p><strong>Conclusions: </strong>Compared with DDD mode, DDD-CLS pacing provided physiological chronotropic support to improve cardiopulmonary function during exertion, which enhanced lung capacity in patients with CI.</p>\",\"PeriodicalId\":2,\"journal\":{\"name\":\"ACS Applied Bio Materials\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":4.6000,\"publicationDate\":\"2024-10-20\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"ACS Applied Bio Materials\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1016/j.jfma.2024.10.009\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"MATERIALS SCIENCE, BIOMATERIALS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"ACS Applied Bio Materials","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.jfma.2024.10.009","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"MATERIALS SCIENCE, BIOMATERIALS","Score":null,"Total":0}
Improving lung function capacity in patients with chronotropic incompetence using closed loop stimulation: A randomized crossover study.
Background: Chronotropic incompetence (CI) severely limits exercise tolerance due to impaired heart rate responses. This study investigated whether pacemaker with closed-loop stimulation (DDD-CLS) pacing, which provides rate acceleration in response to exertion, could enhance lung function and cardiopulmonary capacity compared pacemaker without CLS pacing in patients with CI.
Methods: This randomized crossover trial included 32 patients with CI who were compared to each CLS and DDD pacing over 2 months. Spirometry was used to assess the forced vital capacity (FVC). Cycling-based cardiopulmonary exercise testing (CPET) measured peak oxygen uptake (peak VO2).
Results: DDD-CLS pacing yielded significantly higher FVC (2.2 ± 0.8 L) versus DDD pacing (2.0 ± 0.7 L), p = 0.036, a 3.2% improvement. Moreover, those in the DDD-CLS mode showed a significantly higher FEV1 of 1.8 ± 0.6 L compared to the DDD mode of 1.7 ± 0.5 L (p = 0.03). Compared with DDD pacing, DDD-CLS pacing also achieved superior peak VO2 (14.9 ± 4.0 vs 12.2 ± 3.7 mlO2/kg/min, p < 0.001) and peak heart rate (106.9 ± 9.7 vs 98.3 ± 19.8 bpm, p = 0.013). DDD-CLS and DDD pacing modes showed significant correlations between FVC and peak VO2 and between peak VO2 and peak heart rate during CPET.
Conclusions: Compared with DDD mode, DDD-CLS pacing provided physiological chronotropic support to improve cardiopulmonary function during exertion, which enhanced lung capacity in patients with CI.
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