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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2007. For permissions please email: journals.permissions@oxfordjournals.org

Evolution of pacing for bradycardias: sensors

Chu-Pak Lau1,*, Hung-Fat Tse1, A. John Camm2 and Serge S. Barold3

1 Cardiology Division, University Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong
2 Department of Cardiovascular Sciences, St George’s Hospital, Medical School, London, UK
3 Tampa General Hospital, Tampa, FL, USA

* Corresponding author. Fax: +852 2818 6304. E-mail address: cplau{at}hkucc.hku.hk

A physiological pacing system should be able to restore normal chronotropic response and optimal conduction within and between the atrial and ventricular pacing. Implantable sensors are initially developed to overcome chronotropic incompetence of the sinus node to exercise and non-exercise requirements. Ideal sensor behaviour includes speed of response, proportionality, specificity, and sensitivity. Sensors can be classified by the method they detect a physiological change: body accelerations, paced QRS, impedance and sensors that require special leads. Rate-adaptive pacing is proven to improve exercise capacity and oxygen consumption over fixed-rated pacing, especially during ventricular pacing. Patients with chronotropic incompetence can derive symptomatic benefit in the rate-adaptive mode. The latest development involves the use of sensors to monitor heart failure, and to best optimize rate and conduction status in cardiac resynchronization therapy.

Key Words: Chronotropic incompetence • Exercise • Pacing • Rate-adaptive pacing • Sensor • Sinus node disease


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