Rate adaptive pacing in an intracardiac pacemaker
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- 作者：Michael Lloyd ; MD ; FHRS* ; mlloyd2@emory.edu ; Dwight Reynolds ; MD&dagger ; ; Todd Sheldon ; MS&Dagger ; ; Kurt Stromberg ; MS&Dagger ; ; J. Harrison Hudnall ; BS&Dagger ; ; Wade M. Demmer ; MBA&Dagger ; ; Razali Omar ; MD§ ; ; Philippe Ritter ; MD¶ ; ; John Hummel ; MD║ ; Lluí ; s Mont ; MD** ; Clemens Steinwender ; MD&dagger ; &dagger ; ; Gabor Z. Duray ; MD ; PhD&Dagger ; &Dagger ;
- 关键词：Leadless pacemaker ; Intracardiac pacemaker ; Accelerometer ; Rate adaptive ; Rate response
- 刊名：Heart Rhythm
- 出版年：2017
- 出版时间：February 2017
- 年：2017
- 卷：14
- 期：2
- 页码：200-205
- 全文大小：726 K
- 卷排序：14
文摘
The Micra transcatheter pacemaker was designed to have similar functionality to conventional transvenous VVIR pacing systems. It provides rate adaptive pacing using a programmable 3-axis accelerometer designed to detect patient activity in the presence of cardiac motion.ObjectiveThe purpose of this study was to evaluate the system’s performance during treadmill tests to maximum exertion in a subset of patients within the Micra Transcatheter Pacing Study.MethodsPatients underwent treadmill testing at 3 or 6 months postimplant with algorithm programming at physician discretion. Normalized sensor rate (SenR) relative to the programmed upper sensor rate was modeled as a function of normalized workload in metabolic equivalents (METS) relative to maximum METS achieved during the test. A normalized METS and SenR were determined at the end of each 1-minute treadmill stage. The proportionality of SenR to workload was evaluated by comparing the slope from this relationship to the prospectively defined tolerance margin (0.65–1.35).ResultsA total of 69 treadmill tests were attempted by 42 patients at 3 and 6 months postimplant. Thirty tests from 20 patients who completed ≥4 stages with an average slope of 0.86 (90% confidence interval 0.77–0.96) confirmed proportionality to workload. On an individual test basis, 25 of 30 point estimates (83.3%) had a normalized slope within the defined tolerance range (range 0.46–1.08).ConclusionAccelerometer-based rate adaptive pacing was proportional to workload, thus confirming rate adaptive pacing commensurate to workload is achievable with an entirely intracardiac pacing system.