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European Heart Journal 1985 6(10):891-896;
Copyright © 1985 by the European Society of Cardiology.
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© 1985 The European Society of Cardiology

Identification of pacemaker dependent patients by serial decremental rate inhibition

J. C. P. CRICK, S. ROKAS* and E. SOWTON

Department of Cardiology, Guy's Hospital St. Thomas Street, London SEI 9RT, U.K.

Received 25 February 1985; revised 11 June 1985; .

Abstract

In a study of the concept of pacemaker dependence, 86 patients who had permanent ventricular demand ( VVI) pacemakers implanted for more than six months and were in predominantly paced rhythm underwent repeated interruption of pacing both abruptly and after gradual reduction of paced rate. Non-invasive pace slowing was accomplished by timed inhibiting pulses applied to the chest wall. The results identified a small group (A) of patients, 8% of those tested, who consistently failed to develop an adequate escape rhythm and may thus be considered highly pacing dependent. A second group B, 26%, developed an adequate intrinsic rhythm with serial decremental rate inhibition (SDRI) but suffered symptoms with abrupt complete inhibition (ACI). The remaining 66%, group C, developed no symptoms in any test. Analysis of clinical pre-test data showed that syncope, atrioventricular block and a low rate prior to implant, and a long duration of pacing were associated with a higher degree of pacing dependence, but were not reliably predictive. The clinical significance and value of the results are discussed. We conclude that SDRI is a reliable test for the high degree of pacemaker dependence and can be helpful especially in planning a procedure which may involve interruption of pacing.

Key Words: Pacemaker dependence • reproducibility • chest wall stimulation


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