Abstract
Chronotropic incompetence (CI) describes the inability of the heart to adequately increase its rate in response to increased activity or demand. Chronotropic incompetence is common in patients with cardiovascular disease, produces exercise intolerance, impairs quality of life, and is an independent predictor of major adverse cardiovascular events and overall mortality. The diagnosis of CI should take into account the confounding effects of aging, physical condition, and medications but can be achieved objectively with the use of widely available exercise testing methods and standardized definitions. The prognostic information of CI remains preserved in patients treated with β-Blockers. Therefore, the use of separate CI criteria for these patients does not appear necessary. The role of rate-adaptive pacing in patients with CI remains to be determined, although this technique showed promising results in small studies and individual patients. In addition, exercise training can reduce the extent of CI in patients with heart failure and thereby improve functional capacity and symptomatic state.
