Clinical Experience with an Activity Sensing DDDR Pacemaker Using an Accelerometer Sensor

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Abstract
The rate adaptive characteristics and pacemaker mediated tachycardia protection algorithm of an accelerometer based DDDR pacemaker were evaluated in 11 patients with bradycardia (seven atrioventricular block, four sick sinus syndrome). Rate adaptive programming was effected by collecting the acceleration level during a 3‐minute moderate exercise (“tailoring” of sensor). In comparison with an externally attached piezoelectric sensor, the accelerometer sensor showed lower rate changes during external tapping of the pacemaker (16 ± 3 vs 29 ± 4 ppm, P < 0.02) and applied direct pressure (1 ± 1 vs 40 ± 3 beats/min, P < 0.001) on the pacemaker. At nominal setting, the accelerometer sensor showed improved rate stability and higher rate response to jogging and standing, although responses to other daily activities and treadmill exercise were similar. Apart from changing the rate responsive slope, rate response could be improved by repeat “tailoring” of the sensor at a lower exercise level, resulting in better overall rate response characteristics. The ability of the rate monitoring software to collect acceleration levels for an activity and profile the projected rate response at different rate responsive settings allowed programming to be effected with the minimum amount of exercise testing. The pacemaker also discriminated atrial tachyarrhythmias from normal sinus response using the sensor to judge the appropriateness of the atrial rate, which correctly identified and prevented rapid ventricular tracking in two patients during atrial flutter/fibrillation.