The Promise of Improved Exercise Performance by Dual Sensor Rate Adaptive Pacemakers

The incorporation of artificial sensors in implantahle systems has revolutionized the technology and clinical practice of cardiac pacing.̂ Although hasic sensor technology has not changed much over the last decade, progress in microprocessor technology, improved algorithms, and the comhinations of sensors have created devices designed to replicate the physiological rate response hetter than in the past. No single sensor is ahle to reproduce the rate response of the normal sinus node. Each individual sensor has advantages and disadvantages, despite considerahle refinement of the algorithms used to translate sensor input into an appropriate pacing rate. For this reason Lau and Camm^ wrote recently that "sensors for the purpose of rate modulation may he comhined to improve the speed of rate response at the onset of exercise, proportionality of heart rate to work load, differential sensitivity to physiological changes induced hy exercise and nonexercise stresses, and rejection of unwanted environmental artifacts. These comhinations aim to create a sensor system that hest simulates the sinus node response in normal individuals." Popular comhinations of sensors for rate control all include a hasic activity sensor hecause it provides an important rapid response to light exercise of short duration. A nonactivity sensor, such as minute ventilation or QT, is added to provide a somewhat delayed proportional and stahle physiological response to exercise and recovery.

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