Physiologic pacing in the elderly. Effects on exercise capacity and exercise-induced arrhythmias.

It is not clear whether hemodynamic and other benefits from dual-chamber pacing also exist in elderly patients. We studied a group of 18 elderly patients (mean age 74 +/- 4 yrs) with exercise testing in DDD and VVI modes in a randomized way to compare the effects of these pacing modes on exercise capacity, atrial rate and exercise-induced arrhythmias. Patients were selected when complete heart block was present without clinical evidence of sinus node dysfunction. Significant differences were observed: atrial rate was lower during exercise in DDD-mode (p less than 0.01); exercise time and cumulative load increased (p less than 0.05); maximal oxygen uptake was improved (p less than 0.05). Some of these differences were less clear in a subgroup with replacement of a VVI-device by DDD-stimulation. No differences could be observed in severity of exercise-induced arrhythmias. No evidence of sinus node dysfunction was found during exercise. Reprogramming of atrial sensitivity was required in 3 patients, with reprogramming to DVI because of paroxysmal atrial fibrillation once. Two patients died within a mean follow-up period of 13 months. Sinus rhythm was present at the most recent evaluation in all patients, including the patient stimulated in the DVI mode. Physiologic stimulation is of value for elderly patients with an active life style and complete heart block. Reprogramming to another pacing mode is only seldom necessary.

RCT Entities:   Population Interventions Outcomes