title: Delayed exercise rate response kinetics due to sensor cross-checking in a dual sensor rate adaptive pacing system: the importance of individual sensor programming.
abstract: By cross-checking the relative sensor activation between a nonspecific and specific sensor during extraneous interference, a multisensor rate adaptive pacemaker may be able to limit inappropriate rate responses. The effects of activity (ACT) sensor programming on rate response kinetics of a QT and ACT dual sensor VVIR pacemaker with sensor cross-checking algorithm were studied in four patients with atrial fibrillation and complete heart block. The rate adaptive setting of each sensor was individually optimized, and an equal rate contribution for the QT and ACT sensors (QT = ACT) was used in the dual sensor VVIR mode. Three maximal treadmill exercise tests were performed in random order in three different VVIR modes driven by QT only, QT = ACT, and in the dual sensor mode with the most sensitive (low threshold) ACT setting. In the two dual sensor modes, the time for onset of rate response (delay time) was reduced (both < 15 sec) compared with QT only VVIR mode (233 +/- 70 sec). However, the time to 50% of rate response in the low ACT threshold dual sensor mode was delayed compared with to QT = ACT (450 +/- 110 [95% confidence interval 234-666] vs 311 +/- 103 [109-513]sec, P < 0.05) and was similar to the QT only mode (401 +/- 120 [166-636]sec). The time to reach 90% of rate response was similar in the three modes tested. The resting activity counts registered by the ACT sensor were < 5 and 16 +/- 2 counts/min in the optimally programmed and low threshold ACT settings, respectively. This resulted in sensor cross-checking at rest in the overprogrammed dual sensor VVIR mode, thereby limiting the rate response. Thus, the combined sensor system provides a faster initial response to exercise than the QT only sensor. Programming the ACT threshold to low will prevent this faster response because of sensor cross-checking.
authors.affiliation: Department of Medicine, University of Hong Kong, Queen Mary Hospital, Hong Kong.
authors.forename: C P
authors.initials: CP
authors.lastname: Lau
authors.forename: S K
authors.initials: SK
authors.lastname: Leung
authors.forename: I S
authors.initials: IS
authors.lastname: Lee
mesh_terms: D000465:Algorithms; D001281:Atrial Fibrillation / Q000628:therapy*; D002304:Cardiac Pacing, Artificial / Q000379:methods*; D015444:Exercise / Q000502:physiology; D005080:Exercise Test; D005260:Female; D006327:Heart Block / Q000628:therapy*; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010138:Pacemaker, Artificial; D012984:Software; D013997:Time Factors