Is a dual-sensor pacemaker appropriate in patients with sino-atrial disease? Results from the DUSISLOG study.
BACKGROUND
Rate-responsive pacemakers (PMs) are often supplied with accelerometer (XL) and minute ventilation (MV) sensors to provide a physiologic rate response according to patient needs. No information is available about the real benefit of dual-sensor rate-responsive pacing on the daily life of patients.


METHODS
DUSISLOG (Dual Sensor vs Single Sensor comparison using patient activity LOGbook) is a two-arm prospective, randomized, multicenter study that enrolled 105 patients who received a rate-responsive PM (Insignia), Guidant Corp.). After 1 month of DDD pacing at 60 ppm lower rate, a single sensor (XL or MV, randomized) was activated for 3 months at the manufacturer's suggested nominal settings, followed by a 3-month period with dual sensors optimized with automatic response. During the last month of each period, the following data concerning patient physical activity were retrieved from PM diagnostics (Activity Log): mean percentage of physical activity, mean intensity of activity. Quality of life (QoL) scores and 6-minute walk test (WT) were also recorded.


RESULTS
Single-sensor rate-responsive pacing resulted in symptomatic benefit equally with XL and MV sensors while no additional benefit was found using dual sensor. In a subgroup analysis, patients (17%) with marked chronotropic incompetence and with 0% atrial sensing received benefits from single sensor with an additional advantage from sensor (QoL: +21 +/- 14% P < 0.05; WT: +17 +/- 7% P < 0.02).


CONCLUSIONS
In most patients with rate-responsive devices, a single sensor is sufficient to achieve a satisfactory rate response. A dual sensor combination and optimization provides an additional benefit only in a selected population with an advanced atrial chronotropic disease.
Padeletti
Luigi
L
Ist. Di Clinica Medica e Cardiologia, Osp. Careggi, Firenze, Italy. lpadeletti@interfree.it
Pieragnoli
Paolo
P
Di Biase
Luigi
L
Colella
Andrea
A
Landolina
Maurizio
M
Moro
Eugenio
E
Orazi
Serafino
S
Vicentini
Alfredo
A
Maglia
Giampiero
G
Pensabene
Orazio
O
Raciti
Giovanni
G
Barold
S Serge
SS
D000368:Aged; D005260:Female; D006801:Humans; D007558:Italy; D008297:Male; D010138:Pacemaker, Artificial; D011174:Portugal; D011446:Prospective Studies; D011788:Quality of Life; D012804:Sick Sinus Syndrome / Q000503:physiopathology / Q000628:therapy*; D018709:Statistics, Nonparametric; D016896:Treatment Outcome