Physical work capacity with rate responsive ventricular pacing (VVIR) versus dual chamber pacing (DDD) in patients with normal and diminished left ventricular function

To determine the benefit of atrial contribution on work capacity in relation to left ventricular ejection fraction, we studied 17 patients (68 ± 13 years) with dual chamber pacemakers (DDD) implanted for high degree atrioventricular (AV) block. In random order they were assigned to rate responsive ventricular (VVIR) and to atrial triggered ventricular (VDD) stimulation. Maximum oxygen uptake (max Vo2), that correlates best with work capacity, was measured by spiroergometry at a respiratory quotient of 1.1 during treadmill exercise test. Left ventricular ejection fraction at rest was determined by radionuclide ventriculography during VDD-stimulation and an AV delay of 150 ms. There were no differences between these two pacing modes relating heart rate, blood pressure, minute ventilation, exercise duration and maximal work load. In eight patients with an ejection fraction >50% (60 ± 10%), but not in nine patients with an ejection fraction <50% (41 ± 10%), maximum oxygen uptake was significantly higher (P < 0.01) during atrial triggered ventricular pacing (1440 ± 533 ml/min) compared with rate responsive ventricular pacing (1328 ± 536 ml/min). Thus, rate responsive single chamber pacemakers largely enable the same work capacity as dual chamber pacemakers in patients with high degree AV block. Patients with normal left ventricular function may profit most from preserve AV synchrony as shown by the higher maximum oxygen uptake on exercise.