Closed-Loop Stimulation (CLS) Function Improved Respiratory Measurements of the Implanted Pacemaker Patient with Chronotropic Incompetence

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Background: CLS function continuously monitors cardiac contraction dynamics through intracardiac local electrical impedance measurement via a ventricular pacing lead. By direct assessment of variations in impedance, which reflect the ventricular wall motion in the close vicinity of the pacing electrode, the CLS function translates the cardiac contraction dynamics into its pacing rates. CASE/Methods: 71-year-old female had implanted the pacemaker (KIKROS; BIOTRONIK, GERMANY) for treatment of sick sinus syndrome. Her cardiac contraction was normal, and ECG is atrial-pacing rhythm at rest. We examined the rate-response and several respiratory measurements on the cardio pulmonary exercise test (CPX), and compared the effect of CLS sensor with the conventional acceleration sensor. Result: During DDD-CLS mode, respiratory measurements were improved more than DDDR mode (acceleration sensor). During DDDR mode, heart rate (HR) was not changed. On the other, during DDD-CLS mode, HR was gradually increased by the CPX. CLS pacing function improved her ventilatory threshold. Conclusion: CLS function is considered to provide more appropriate and physiological cardiac pacing than the rate adaptive pacing of the accelerometer sensors.