Heart rate score, a measure related to chronotropic incompetence in pacemaker patients.

BACKGROUND

Heart rate score (HrSc) ≥70% in cardiac resynchronization therapy defibrillator and implantable cardioverter-defibrillator subjects predicts 5-year mortality risk. A high HrSc suggests few sensed cardiac cycles above the programmed lower rate.

OBJECTIVE

To determine if HrSc is related to chronotropic incompetence (CI) in pacemaker (PM) subjects.

METHODS

HrSc is the percentage of all atrial-paced and sensed events in the single tallest 10 beats/min histogram bin programmed to DDD 60/min. The prospective LIFE study of PM subjects examined multiple treadmill-based measures of CI. The 1-month postimplant DDD 60/min PM rate histogram prior to treadmill was retrospectively analyzed for HrSc. Measures of CI were applied to submaximal treadmill data in the DDD mode. HrSc was compared to these CI measures and to clinical indications for PM.

RESULTS

The 1-month histogram demonstrated HrSc ≥70% in 43% of subjects. HrSc ≥70% correlated with a clinical diagnosis of sick sinus syndrome (P < .001). CI was present in 34%-88% of subjects by treadmill-based measures. Agreement between treadmill-based measures for CI was poor and varied from 39% to 83%. HrSc ≥70%, as a measure of CI, was most highly correlated with unpaced heart rate <70% of age-predicted maximum heart rate (67%) (odds ratio 3.7, P < .001).

CONCLUSIONS

HrSc ≥70% correlates with treadmill measures of CI and clinical sick sinus syndrome. HrSc ≥70% is a measure of CI in PM subjects that is inexpensive, repeatable, and quantitative.