Key result
Dual sensor rate adaption provided a more physiological response during exercise than single sensors, with a smaller mean difference from intrinsic sinus rates (16.2 vs 34.8 beats/min for ACC).
Why the study?
Does dual sensor rate adaptation improve physiological heart rate response compared to single sensors in chronotropically competent patients during exercise?
Does dual sensor rate adaptation improve physiological heart rate response compared to single sensors in chronotropically competent patients during exercise?
Dual sensor rate adaptation provides a more physiological heart rate response than single sensors during exercise, though it still does not perfectly mimic normal sinus rhythm.
Supports dual-sensor pacing for more physiological exercise rates; hypothesis-generating and should not yet change practice.
BACKGROUND: Dual sensor (DS) for rate adaption was supposed to be more physiological. To evaluate its superiority, the DS (accelerometer [ACC] and minute ventilation [MV]) and normal sinus rate response were compared in a self-controlled way during exercise treadmill testing. METHODS: This self-controlled study was performed in atrioventricular block patients with normal sinus function who met the indications of pacemaker implant. Twenty-one patients came to the 1-month follow-up visit. Patients performed a treadmill test 1-month post implant while programmed in DDDR and sensor passive mode. For these patients, sensor response factors were left at default settings (ACC = 8, MV = 3) and sensor indicated rates (SIRs) for DS, ACC and MV sensor were retrieved from the pacemaker memories, along with measured sinus node (SN) rates from the beginning to 1-minute after the end of the treadmill test, and compared among study groups. Repeated measures analysis of variance and profile analysis, as well as variance analysis of randomized block designs, were used for statistical analysis. RESULTS: Fifteen patients (15/21) were determined to be chronotropically competent. The mean differences between DS SIRs and intrinsic sinus rates during treadmill testing were smaller than those for ACC and MV sensor (mean difference between SIR and SN rate: ACC vs. SN, MV vs. SN, DS vs. SN, respectively, 34.84, 17.60, 16.15 beats/min), though no sensors could mimic sinus rates under the default settings for sensor response factor (ACC vs. SN P-adjusted < 0.001; MV vs. SN P-adjusted = 0.002; DS vs. SN P-adjusted = 0.005). However, both in the range of 1 st minute and first 3 minutes of exercise, only the DS SIR profile did not differ from sinus rates (P-adjusted = 0.09, 0.90, respectively). CONCLUSIONS: The DS under default settings provides more physiological rate response during physical activity than the corresponding single sensors (ACC or MV sensor). Further study is needed to determine if individual optimization would further improve adaptive performance of the DS.
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Cao et al. (2014) studied Atrioventricular block with normal sinus function (n=21). Dual sensor (accelerometer and minute ventilation) rate adaption vs. Single sensor (accelerometer or minute ventilation) and normal sinus rhythm was evaluated on Mean difference between sensor indicated rate and intrinsic sinus rate during exercise (MD 16.2, 95% CI 3.6-28.7, p=0.005). Dual sensor rate adaption provided a more physiological response during exercise than single sensors, with a smaller mean difference from intrinsic sinus rates (16.2 vs 34.8 beats/min for ACC).
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