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Heart 1998;80:383-386 ( October )

"Value" of improved treadmill exercise capacity: lessons from a study of rate responsive pacing

A D Staniforth, R Andrews, M Harrison, A Perry, A J Cowley

Department of Cardiovascular Medicine, Queen's Medical Centre, University of Nottingham, Nottingham, UK

Correspondence to: Dr A D Staniforth, Department of Cardiology, Newham General Hospital, Glen Road, Plaistow, London E13 8SL, UK.

Accepted for publication 27 January 1998

Objectives---To compare the value of a series of cardiovascular measurements in patients with symptomatic disease receiving an effective treatment (rate responsive pacing).
Patients---12 pacemaker dependent patients with VVIR units.
Interventions---Single blind crossover between VVI and VVIR.
Outcome measures---Exercise capacity was assessed by treadmill tests (modified Bruce protocol and a fixed workload protocol) with respiratory gas analysis. Self paced corridor walk tests were also undertaken. Quality of life (QOL) was assessed by questionnaire. Daily activity was measured in the patients' homes using shoe and belt pedometers.
Results---Treadmill tests and QOL questionnaires correctly identified the clinical benefit associated with VVIR. The modified Bruce protocol was superior to the fixed workload protocol as it was better tailored to the fairly well preserved exercise capacity of the patients. Symptom scores, but not walking times, were improved with VVIR during corridor walk tests. VVIR did not improve daily activity measured using either the belt or shoe pedometers.
Conclusions---VVIR pacing improved some but not all measures of exercise capacity. This finding illustrates the difficulty of selecting an instrument to measure symptomatic improvement in clinical research; and raises the question, what is the best way of measuring exercise capacity?

Keywords: rate responsive pacing;  exercise capacity;  quality of life

© 1998 by Heart


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J D SOMAUROO and D T CONNELLY
Value of improved treadmill exercise capacity
Heart, April 1, 1999; 81(4): 451b - 452.
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