CLS and Heart Failure

Cardiac Rhythm Management // CLS and Heart Failure
CLS and Heart Failure
Therapy folder
CLS and Heart Failure
Therapy folder
387 487/A /1307
1 Jorde UP et al.; European Journal of Heart Failure; 10 (2008) 96–101.
2Garcia LI et al.; Chronotropic incompetence is an independent predictor of mortality in patients with advanced CHF; J Am Coll Cardiol 2009;
53: A194.
3Peter H. Brubaker, et al., Chronotropic Incompetence - Causes, Consequences, and Management, Circulation. 2011; 123: 1010–1020.
4Tse HF et al.; The incremental benefit of rate-adaptive pacing on exercise performance during cardiac resynchronization therapy;
J Am Coll Cardiol 2005; 46: 2292–7.
Maass AH. Importance of heart rate during exercise for response to cardiac resynchronization therapy. J Cardiovasc Electrophysiol 2009;
5
20: 773-80
6Sims D. B. et al.; Rate responsive pacing using cardiac resynchronisation therapy in patients with chronotropic incompetence and chronic
heart failure. Europace 2011
7Beliaev O.V. et al.; Heart Rate Variability over 24 Hours – Closed Loop Stimulation and Motion-Sensor Pacemakers Compared with Healthy
Control Group; Prog. Biomedical Res. 1999; Vol. 4; 146–148
8Wojciechowski D et al.; Clinical Results of Contractility-Based Closed Loop Stimulation in Patients Treated with Beta-Blockers; Prog
Biomed Res 2001; Vol 6: 303–307.
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70% of CHF patients have
chronotropic incompetence (CI)
CI occurs in over 70 % of advanced systolic CHF
patients irrespective of beta-blocker use1
CI is an independent predictor of mortality.2
Physiological rate with CLS
Appropriate rate is the key
20 % increase in VO2 max can be achieved using an
No CI 30%
CI 70%
HF patients need an appropriate increase in HR to compensate
appropriate rate adaptive pacing in HF patients with
severe CI (< 70% HR)6
for their inadequate stroke volume during physical exertion.3,4
Oxygen consumption in CI patients
Cumulative incidence of death in HF patients
40
CI present
CI absent
35
Peak oxygen consumption
(ml/kg/min)
CI increases the risk of death
22
DDD CRT-pacing
DDDR CRT-pacing
p < 0.05
20
18
16
Peak oxygen consumption during
DDD and DDDR modes in patients
who achieved 70% (n 11), and 70% to
85% (n 9) of age-predicted HR during
exercise using DDD-OFF mode
14
12
10
0
< 70%
30
70–85%
25
20
15
CLS makes the difference
10
5
CLS is not based on movement of the patient, which
0
0
CIPre 113
CIAbs 57
5
10
15
20
65
49
65
45
38
37
26
32
25
might be very limited in patients with severe CHF.1
months
CLS is the only rate-adapting algorithm reacting both
on physical and mental stress.
CI is associated with CRT non-response
CLS is not influenced by the patients’ drug therapy.7
CI is a predictor for non-response to CRT in patients in sinus rhythm.5
Heart Rate in β-blocked patients
NN responders
Total
CI
36%
Responders
At 6 months of follow-up, responders
significantly less frequently were
chronotropic incompetent: responders
10% versus non-responders 36 %
10%
0
10
20
30
40
50
60 (%)
Heart rate (beats/min)
Chronotropic Incompetence in non-responders HF patients
140
Beta-blocker
No Beta-blocker
120
100
80
60
No significant difference between patients
with/without β-blocker use, during different
kinds of physical activities.8
40
20
0
Day
Night
Rest
Walk
Stairs
down
Stairs
up