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Article: Transient overdrive pacing upon standing prevents orthostatic hypotension in elderly pacemaker patients with chronotropic incompetence

TitleTransient overdrive pacing upon standing prevents orthostatic hypotension in elderly pacemaker patients with chronotropic incompetence
Authors
KeywordsOrthostatic hypotension
Pacing
Issue Date2007
PublisherWiley-Blackwell Publishing, Inc. The Journal's web site is located at http://www.wiley.com/bw/journal.asp?ref=0147-8389&site=1
Citation
Pace - Pacing And Clinical Electrophysiology, 2007, v. 30 n. 2, p. 188-192 How to Cite?
AbstractBackground: Elderly pacemaker patients with chronotropic incompetence (CI) may experience orthostatic hypotension (OH) upon standing. The objective of this study was to determine whether a transient increase in heart rate (HR) by overdrive pacing upon standing prevents OH in elderly pacemaker patients. Methods: We studied the effect of transient overdrive pacing upon standing in mitigating the drop in blood pressure (BP) in 62 pacemaker patients (77 ± 6 years, 32 F) implanted with DDD pacemaker for sick sinus syndrome (n = 40) or atrioventricular block (n = 22). All patients underwent two standing procedures in random order: a control, with backup (60 bpm) pacing and another with overdrive DDD pacing (at 35 bpm above their baseline rate) for 2 minutes upon standing. Systolic (SBP) and diastolic blood pressure (DBP) and HR were measured while supine (baseline) and 1, 2, and 3 minutes after standing. OH was defined as a drop in SBP ≥20 mmHg or DBP ≥10 mmHg during standing. Chronotropic incompetence (CI) was defined as an absence of HR increase of ≥10 bpm during standing. Results: A total of 17 (27%) patients developed OH upon standing during backup pacing. Baseline clinical characteristics (age, sex, prevalence of diabetes, use of vasoactive medications, and sick sinus syndrome) were similar between patients with or without OH. In patients with or without OH, transient overdrive pacing upon standing increased HR and DBP as compared with baseline (P < 0.05). However, in patients with OH, transient overdrive pacing did not prevent decrease in SBP upon standing and avoided the development of OH in only 10/17 patients (59%). Among those patients with OH, 10/17 (59%) patients had CI. In OH patients with CI, transient overdrive pacing upon standing maintained SBP and DBP as compared to baseline and prevented OH in the majority of patients (80%). By contrast, transient overdrive pacing in OH patients without CI had no significant effect on the decrease in SBP upon standing and prevented OH in only 20% of patients. Conclusions: OH is common (27%) in the elderly pacemaker population. In a subgroup of these patients, CI may be responsible for the occurrence of OH, and OH can be prevented by transient overdrive pacing upon standing. © 2007, The Authors.
Persistent Identifierhttp://hdl.handle.net/10722/76909
ISSN
2015 Impact Factor: 1.156
2015 SCImago Journal Rankings: 0.662
ISI Accession Number ID
References

 

DC FieldValueLanguage
dc.contributor.authorTse, HFen_HK
dc.contributor.authorLau, CPen_HK
dc.contributor.authorPark, Een_HK
dc.contributor.authorBornzin, GAen_HK
dc.contributor.authorYu, Cen_HK
dc.contributor.authorBenser, MEen_HK
dc.contributor.authorBloomfield, DMen_HK
dc.contributor.authorPadeletti, Len_HK
dc.date.accessioned2010-09-06T07:26:13Z-
dc.date.available2010-09-06T07:26:13Z-
dc.date.issued2007en_HK
dc.identifier.citationPace - Pacing And Clinical Electrophysiology, 2007, v. 30 n. 2, p. 188-192en_HK
dc.identifier.issn0147-8389en_HK
dc.identifier.urihttp://hdl.handle.net/10722/76909-
dc.description.abstractBackground: Elderly pacemaker patients with chronotropic incompetence (CI) may experience orthostatic hypotension (OH) upon standing. The objective of this study was to determine whether a transient increase in heart rate (HR) by overdrive pacing upon standing prevents OH in elderly pacemaker patients. Methods: We studied the effect of transient overdrive pacing upon standing in mitigating the drop in blood pressure (BP) in 62 pacemaker patients (77 ± 6 years, 32 F) implanted with DDD pacemaker for sick sinus syndrome (n = 40) or atrioventricular block (n = 22). All patients underwent two standing procedures in random order: a control, with backup (60 bpm) pacing and another with overdrive DDD pacing (at 35 bpm above their baseline rate) for 2 minutes upon standing. Systolic (SBP) and diastolic blood pressure (DBP) and HR were measured while supine (baseline) and 1, 2, and 3 minutes after standing. OH was defined as a drop in SBP ≥20 mmHg or DBP ≥10 mmHg during standing. Chronotropic incompetence (CI) was defined as an absence of HR increase of ≥10 bpm during standing. Results: A total of 17 (27%) patients developed OH upon standing during backup pacing. Baseline clinical characteristics (age, sex, prevalence of diabetes, use of vasoactive medications, and sick sinus syndrome) were similar between patients with or without OH. In patients with or without OH, transient overdrive pacing upon standing increased HR and DBP as compared with baseline (P < 0.05). However, in patients with OH, transient overdrive pacing did not prevent decrease in SBP upon standing and avoided the development of OH in only 10/17 patients (59%). Among those patients with OH, 10/17 (59%) patients had CI. In OH patients with CI, transient overdrive pacing upon standing maintained SBP and DBP as compared to baseline and prevented OH in the majority of patients (80%). By contrast, transient overdrive pacing in OH patients without CI had no significant effect on the decrease in SBP upon standing and prevented OH in only 20% of patients. Conclusions: OH is common (27%) in the elderly pacemaker population. In a subgroup of these patients, CI may be responsible for the occurrence of OH, and OH can be prevented by transient overdrive pacing upon standing. © 2007, The Authors.en_HK
dc.languageengen_HK
dc.publisherWiley-Blackwell Publishing, Inc. The Journal's web site is located at http://www.wiley.com/bw/journal.asp?ref=0147-8389&site=1en_HK
dc.relation.ispartofPACE - Pacing and Clinical Electrophysiologyen_HK
dc.subjectOrthostatic hypotensionen_HK
dc.subjectPacingen_HK
dc.subject.meshArrhythmias, Cardiac - complications - prevention & control-
dc.subject.meshCardiac Pacing, Artificial - adverse effects - methods-
dc.subject.meshHeadache - etiology - prevention & control-
dc.subject.meshPosture-
dc.subject.meshAged-
dc.titleTransient overdrive pacing upon standing prevents orthostatic hypotension in elderly pacemaker patients with chronotropic incompetenceen_HK
dc.typeArticleen_HK
dc.identifier.openurlhttp://library.hku.hk:4550/resserv?sid=HKU:IR&issn=0147-8389&volume=30&spage=188&epage=192&date=2007&atitle=Transient+overdrive+pacing+upon+standing+prevents+orthostatic+hypotension+in+elderly+pacemaker+patients+with+chronotropic+incompetence.en_HK
dc.identifier.emailTse, HF:hftse@hkucc.hku.hken_HK
dc.identifier.authorityTse, HF=rp00428en_HK
dc.description.naturelink_to_subscribed_fulltext-
dc.identifier.doi10.1111/j.1540-8159.2007.00648.xen_HK
dc.identifier.pmid17338714-
dc.identifier.scopuseid_2-s2.0-33847402693en_HK
dc.identifier.hkuros126505en_HK
dc.identifier.hkuros126519-
dc.relation.referenceshttp://www.scopus.com/mlt/select.url?eid=2-s2.0-33847402693&selection=ref&src=s&origin=recordpageen_HK
dc.identifier.volume30en_HK
dc.identifier.issue2en_HK
dc.identifier.spage188en_HK
dc.identifier.epage192en_HK
dc.identifier.isiWOS:000244553800007-
dc.publisher.placeUnited Statesen_HK
dc.identifier.scopusauthoridTse, HF=7006070805en_HK
dc.identifier.scopusauthoridLau, CP=7401968501en_HK
dc.identifier.scopusauthoridPark, E=7402224798en_HK
dc.identifier.scopusauthoridBornzin, GA=6602728974en_HK
dc.identifier.scopusauthoridYu, C=7404978038en_HK
dc.identifier.scopusauthoridBenser, ME=6602158430en_HK
dc.identifier.scopusauthoridBloomfield, DM=7006222344en_HK
dc.identifier.scopusauthoridPadeletti, L=7006625150en_HK
dc.identifier.citeulike1135649-

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