• 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, and Su-Kiat Chua.
• School of Medicine, College of Medicine, Fu Jen Catholic University, New Taipei, 24205, Taiwan; Department of Physical Medicine and Rehabilitation, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan.
• J Formos Med Assoc. 2024 Oct 20.

BackgroundChronotropic 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.MethodsThis 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).ResultsDDD-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.ConclusionsCompared with DDD mode, DDD-CLS pacing provided physiological chronotropic support to improve cardiopulmonary function during exertion, which enhanced lung capacity in patients with CI.Copyright © 2024 Formosan Medical Association. Published by Elsevier B.V. All rights reserved.

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