"Chronotropically incompetent patients don't just get older, they have a problem with their electrical system."
Dr. Botti (Cleveland, US)
Chronotropic incompetence is real and can be treated by using the right sensor in the pacemaker.
Before starting the treatment it is important to have a scanning protocol to improve the quality of life of the right patients.
In my practice I use an Assess-Investigate–Confirm protocol to scan for chronotropic incompetence. With this protocol I am able to help more patients and they are very grateful that we have given them back their lives and made them feel young again.
To learn more about this protocol; click on the 'how to identify patients with chronotropic incompetence video' on this website.
Chronotropic incompetence refers to the inability of the heart to regulate its rate appropriately in response to physiologic stress4. There are a variety of definitions of chronotropic incompetence. In general, the diagnosis ranges from failure to achieve 70% to 85% of Age-Predicted Maximum Heart Rate (APMHR) as defined by the Wilkoff model. Clinics specialized in the treatment of cardiac diseases should use the definition they feel comfortable with.
* Percentage of age-predicted maximum heart rate (APMHR)
1. Sinus node disease manifests as symptomatic bradycardia with or without bradycardia-dependant tachycardia. Symptom-rhythm correlation must have been: spontaneously occurring drug induced where alternative drug therapy is lacking
2. Syncope with sinus node disease, either spontaneously occurring or induced at electrophysiological study
3. Sinus node disease manifests as symptomatic chronotropic incompetence: spontaneously occurring drug induced where alternative drug therapy is lackingRead more about the ESC guidelines
It is important to monitor paced patients even if not previously diagnosed with chronotropic incompetence. The prevalence of CI in the pacemaker population is anywhere from 34% to 42% at initial pacemaker implant. The Gwinn study found that the prevalence of chronotropic incompetence does increase over time in pacemaker patients6.
Percentage of patients with CI
Especially pacemaker patients that use beta blockers should be monitored closely for CI. Pacemaker patients often use beta blockers to treat a variety of conditions including arrhythmias, heart failure, hypertension and angina. Therapy with beta blockers leads to a reduction in resting and exercise heart rates. The majority of pacemaker patients being treated with beta blockers were found to be chronotropically incompetent (85%)7.
To recognise the symptoms of chronotropic incompetence in paced patients,
it is useful to verify the histograms in the pacemaker diagnostics on a regular basis.
Chronotropically incompetent patients are typically being paced at the lower rate limit.
See 2 examples below, click to enlarge