This case report describes a 67-year-old male who underwent pacemaker im-plantation for bradycardia and was diagnosed with chronotropic incompetence after exercise stress test revealed a maximal heart rate less than 80% of predicted heart rate. The study evaluated the patient’s exercise capacity using cardiopulmonary ex-ercise (CPX) testing before and after the pacemaker adjustment, from DDD (dual chamber sensing; dual chamber pacing; dual chamber inhibition and stimulation of pacing with movement detection) to CLS (closed loop stimulation) mode. The re-sults of the study showed that the patient’s maximal aerobic capacity improved sig-nificantly from 11.86 to 16.15 ml/min/kg or 3.4 to 4.6 MET after changing the pacemaker mode, indicating an improvement in aerobic capacity. The patient re-ported a better quality of life after the adjustment. The study highlights the influence of cardiac pacing modes on the heart rate response to physical exercise, and how CLS pacemakers are designed to be more sensitive towards exercise detection, which can increase heart rate accordingly. Few studies have used CPX testing to evaluate exercise capacity in patients with chronotropic incompetence, and this case report provides evidence that changing pacemaker settings to CLS mode can im-prove aerobic capacity and thus improve the patient’s quality of life.
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