P Wave Tracking Above the Maximum Tracking Rate in a DDDR Pacemaker

Dual-chamber, rate-modulated pacemakers have recently become available. These devices, whose rate response is determined by the combined input from the intrinsic atrial rate and the sensor-driven rate, have led to some unexpected upper rate behaviors. In the case presented, with the maximum sensor pacing rate at 150 ppm, multiple episodes of apparent P wave tracking occurred above the maximum P wave tracking rate of 100 ppm. This behavior is explained by P waves that inhibit sensor-driven atrial output; inhibition may result in variable maximum tracking rates that are equal to the current sensor-driven rate. This effect appears to have minimal physiological consequence. Its importance lies in its recognition as normal DDDR function so that searches for pacemaker malfunction will not be made.