Clinical evaluation of peak endocardial acceleration as a sensor for rate responsive pacing

An innovative control parameter for rate responsive (RR) pacing that uses a sensor to measure mechanical vibrations generated by the myocardium during the isovolumetric contraction phase (peak endocardial acceleration [PEA]), has been devised by SORIN Biomedica (BEST Living System). To assess the physiological sensitivity of the pacemaker sensor along with reliability of the algorithm to supply appropriate pacing rates three different relationships were examined (linear regression analysis): (1) recorded deltaPEA exercise steps against the calculated energy cost of exercise (MET), (2) exercise pacing rates against predicted values, and (3) deltaPEA against exercise pacing rates. Fifteen patients (mean age 68 +/- 12 years) in NYHA Class I-II, implanted with the BEST Living System (Living 1 DDDR pacemaker) for advanced AVB and/or SSS, underwent one of the following maximal exercise stress protocols: bicycle (25 W, 2-minute steps) or Bruce or Chronotropic Assessment Exercise Protocol (CAEP). Pacing rates for each step were matched against those predicted by a reliable and tested custom software called Pacing Rate Profile Software (PRPS). The PRPS is based on the oxygen pulse reserve (OPR) method (OPR = VO2 reserve divided by heart rate reserve), American College of Sports Medicine (ACSM) formulas for calculating workload/metabolic requirements, and data derived from the Weber functional classes. On the basis of certain patient, data the PRPS then supplies appropriate metabolic pacing rate profiles. In all 15 patients linear regression analysis of deltaPEA against MET, as evaluated during the exercise protocol steps, showed a high correlation (r = 0.97). Likewise, a high correlation was also obtained between PRPS predicted heart rates and exercise pacing rates (r = 0.96) and PEA against exercise pacing rates (r = 0.96). The results of this study show that, through PEA dynamic monitoring, the SORIN Best Living System produces physiological pacing rates that are significantly related to metabolic needs.