Journal Article

Validation by serial standardized testing of a new rate-responsive pacemaker sensor based on variations in myocardial contractility

J. Clémenty, A. Kobeissi, S. Garrigue, P. Jaïs, P. Le Métayer and M. Haïssaguerre

in EP Europace

Published on behalf of European Heart Rhythm Association of the European Society of Cardiology (ESC)

Volume 3, issue 2, pages 124-131
Published in print April 2001 | ISSN: 1099-5129
Published online April 2001 | e-ISSN: 1532-2092 | DOI: http://dx.doi.org/10.1053/eupc.2001.0152
Validation by serial standardized testing of a new rate-responsive pacemaker sensor based on variations in myocardial contractility

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Aims

Preliminary studies have shown that peak endocardial acceleration (PEA), measured by a micro-accelerometer at the right ventricular apex, is highly correlated with left ventricular contractility (dp/dt max). Furthermore, changes in PEA are closely correlated with sinus node rate changes during exercise and during pharmacological interventions. Peak endocardial acceleration has, therefore, been used to drive a rate-responsive DDD pacemaker. This study compared the chronotropic performance of such devices implanted in 14 patients suffering from chronotropic incompetence with that observed in 18 control subjects in normal sinus rhythm.

Methods and Results

Five standardized daily life activities (hall walk, climbing up and down stairs, squatting and hyperventilation) and two types of exercise (Bruce treadmill protocol and bicycle ergometry) were performed in a random order after individual programming of each pacemaker. For each test, a correlation coefficient was calculated between changes in PEA and variations in paced rate, between instantaneous variations in heart rate monitored by telemetry and continuous measurement of heart rate by the pacemaker, and between sensor-driven rate in patients and normal sinus rhythm in controls. The variations in paced heart rate were closely correlated with those observed in subjects with normal sinus rhythm, and proved to be sensitive, specific, rapid and independent of the type of exercise. After optimal programming of the sensor, PEA modulates the heart rate as expected during normal sinus rhythm.

Conclusions

In this study, a single PEA sensor successfully restored chronotropic response in a population of paced patients with severe chronotropic incompetence. Peak endocardial acceleration can be monitored on a beat-to-beat basis, in parallel with heart rate, and the pacemaker can be accurately programmed with a single exercise test.

Keywords: Rate-responsive pacing; pacemaker sensor; peak endocardial acceleration; myocardial contractility

Journal Article.  0 words. 

Subjects: Cardiovascular Medicine

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