Rate Responsive Pacing Using a Minute Ventilation Sensor

Abstract

Minute ventilation, the product of respiratory rate and tidal volume, correlates directly with oxygen consumption, cardiac output, and heart rate. An implantable pacemaker has been developed which allows variation in pacing rate in response to measured changes in minute ventilation. This single chamber system measures transthoracic impedance between the tip electrode of a standard bipolar lead and the pulse generator case. Low amplitude current pulses (1 mA for 15 microseconds) are generated each 50 msec between the the ring electrode and the case. In the adaptive mode, the pulse generator calculates a rate response factor or slope after maximal exercise. This slope, which describes the relationship between pacing rate and minute ventilation together with the pacing rate limits are the only programmable rate responsive features. Minute ventilation rate responsive systems have been implanted in 12 patients (8 females, 4 males), of mean age 63 years. Indications were His bundle ablation (6), acquired complete heart block (4), and sick sinus syndrome (2). At post-implant exercise testing, pacing rate rose within the first minute. Peak rate and time to upper rate were dependent on workload. After exercise, pacing rate remained at peak for up to 2 minutes before a gradual fall to resting rate. Comparative studies of the minute ventilation and the activity sensor pacing systems in the same patients confirmed that the minute ventilation system more closely parallels normal sinus response to activity. The minute ventilation rate responsive pacing system is simple to programme, no special lead is required and the system is highly physiologic.